INDUCTION TRAINING FOR NEWLY APPOINTED DOCTORS UNDER KARNATAKA HEALTH SYSTEMS DEVELOPMENT
Item
- Title
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INDUCTION TRAINING FOR NEWLY
APPOINTED DOCTORS
UNDER
KARNATAKA HEALTH SYSTEMS DEVELOPMENT
- extracted text
-
Donated by Dr. ( M Francis in Feb. 2010
INDUCTION TRAINING FOR NEhJLY
APPOINTED doctors
UNDER
KARNATAKA HEALTH SYSTEMS
dsvelopmsnt
)
PROJECT
READING MATERILS
1
Conducted By
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STATE INSTITUTE OF HEALTH AND FAMILY
V-7ELFARE, BANGALORE-23.
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INDEX
Si
No.
Topic
1.Induction Training to Newiy
Appointed Doctors
2.India Population Project
3.Overview of KHSDP
4.Reproductive & Child Health
Services
5.Obstetric Emergencies
6 . Synopsis (ExtenTled rch
Programme)
)
Name of the
Lecturers
Page No.
Dr.K.B.Makapur,
Director, SIHFW
Dr.K.3.Makapurz
Director, SI HF?7
1-2
3-10
Dr.G.v.Vijayalakshmi
11-26
Dr.G.V.Nagaraj
27-47
Dr.Uma Devi, Prof &
HOD, M.S.Ramaiah '
College, Bangalore
48-63
Dr.G.VuvijayalQkshmi
Consultant, KHSDP
7.Organisational set-up
*— 1
of
H & F.W.Department
64-71
Government Order
82-86
9.Govt.Retirement Rules(97)
P.Ramanathan
87-113
Vilwanathan, CAO-FA
114-132
Or. Thiruna.vukarasu
133-150
Dr.Bevanoor, J.D.,
’ 151-162
U.Examination of injured
Person
12.Management of Drugs
13.Epidemic Disease Act 1997
J 14.Responsibility of Drawing
and
oisoursing Officers
p ■
Or.M.K.Sudharshan
163-165
K.Mruthyaunjaya Swammy
166-180
K.Mruthyaunjaya Swammy
181-197
16.Hospital Management Training
£or C. H. C. Doc tors
Dr.Sathyanarayana
198-208
Sri.Prakasham
209-211
Dr.Kishore Murthy
212-236
Dr. P.N.iIalagi
237-240
Dr.X.Ravi Kumar
241-249
18. Concepts, Principles, Functions
-application in Health
1’anagement
17.National Aids Control
Programme
2°.Surveillance of Communicable
Diseases—Containment,
Measures and Reporting
)
.2.
I
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15.Prevention and detection of
Fraud in Financial Management
m Government
17. Health Management Information
1- ?
72-81
e.H & f.m .Officers Financial
Purpose
10.Retirement Benefit
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No.
r
Topic
Name of the
Lecturers
Page No.
Dr.K.Ravi Kumar
2 2. Du ties of f.\
Hedical OfficQrs in
Primary Health
—Centre
23.Notification of
Diseases
250-254
Dr.K.Ravi Kumar
255-262
<4.departmental inquiries
Dr.M.S.Karkanna
navar, J.O.(Project)
263-270
Sri.r.o.srinivas
271-275
-A0z KHSOP
21.Malaria-Recent
trends
and Control
prevention
<)
25.How to express
your ■feelings
25.national Health
their Objectives Programme
p
Implementation
at PHC^nd Sub-Ientie7 Proc7ramms
Prof.8.A.Sridhar
276-236
•K.8.Makapur
Director, SIHpw
287-309
Dr.D.M. Koradhanya
Math
309- LIV
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INDUCTIOM
training
TO NEVFLY appqintfo
_COV.ER um.
enT p^c'rc^s^
INDUCTION Training is nothing
but the Orientation
to Doctors
Training-?-- '
to make them aware of the
Organisational s^t up of
Department et various levels
from state Level
to Sub-Centre Level
and various
-activities to be carried
out including
providing of
Medical Care z
implementation of
various National Health and
Family
Wei fare Frogr amme s
and Financial and
Administrative responsibilities °f Medical
Officers of PHCs for effective
functioning of the
PHC/Department.
The Induction Training is most ;
needed for ne wly
appointed Doctors for
their smooth and
effective functioning.
:OBJECTIVES OF TRAIN IMG•
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1 .To orient the Doctors
1 regarding the Organisational
Set up and functions <of Health
and Family Welfare
Department from State level
to Sub-Centre leve 1
and their role/responsibliti
es as a Medical
Officer Of PHC/PHU.
2 .To orient the Doctors
regarding the Administrative,
Financial and Management
responsibilities of Medical Officers so as to carry out
smoothly the
functions of Medical Officer.
3 .To orient regarding, planning,
implementation and
monitoring of National Health
and Family Welfare
Programmes in the PHC/PHU
areas and sub-mission
of reports and
returns to th, hl,her a„hC>riti.s
in this regard.
4 .To orient in organising and
Providing of Medical
Care to the sick persons
coming to the PHC/PHUs
and.rererral of cases to higher
Institutions
wherever needed.
5.To orient regarding co-ordinatio
n and co-operation
of Department activities with
NGOs and other
Departments in implementati
on of various Health
and Family Welfare
Programmes in the PHC area,
6 .To orient in
procurement of drugs, chemicals
etc. > required for the
PHCs.
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Health Status and Epidemiology
Health Indicators - Current Status and Tarcrets to the vear 2000
Particulars
Target
1. Population (Millions)
2 . Crude Birth Rate
3. Crude Death Rate
4 . I .M.R.
India
Karnataka
Punjab
West Bengal
47.9
20.3
72.4
21
28.5
22.5
26.3
25.6
9
9.2
8.5
7.0
7.3
below 60
74.0
67.0
55.0
58.0
5. Expectation of
Life at birth
(a) Male
64.0
60.6
62.1
66.6
62.0
(b) Female
64.0
61.7
63.3
66.6
61.9
6 . Percentage of Eligible
couples effectively
protected
60.0
45.5
49.0
63.7
37.2
7. Annual Growth Rate
of population
1.2
2.1
3.19
2.1
2.2
8. Pregnant Mothers
receiving A N Care
100.0
78.1
84.0
51.0
80.0
9. Deliveries by Trained
Birth Attendants
100.0
69.8
(a) T.T.(for pregnant
mothers)
100.0
78.1
70.0
91.3
80.9
(b) D.P.T.(Infants)
100.0
88.8
69.3
90.9
84.9
(c) Polio ( -do-)
100.0
89'.2
69.5
90.4
85.5
(d) B.C.G.( -do-)
100.0
92.6
73.1
88.2
96.2
70.0
10. Immunisation Status
% coverage
* Source Sample Registration Survey.
INDIA POPULATION PROJECTS
£ // H Pu
6The India Population Projects are
imp lamented wi
th^T/^'
with
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financial
assistance from Government of Tncua and
■^ncia and International
^velopment Agency (IDA).
This projects are
supportive for
the success of
Family Welfare and Mother-Child
Health Programme
to achieve the
crude Birth Rateof 21/1000
population by year
2000 AD and also other Health
Indicators.
The India Population projects implemented
in the State
are as follows;1’March 198otati°n Project-1' In-Plemented from April 1973 to
^nefited - AU the Districts of
Bangalore Division
1th the following objectives:
- Expansion of Health infrastructure
- linking the provision of F.P. Services with
supplimentary
Nutrition Programme
’ contUual^aU^ind
1^ centre
Centre/°
eValuate Performance on
population
to evaluate
perfo^ancA
deSlgn
°Perate
and evaluate
performance.
J
- Provision of technical assistance.
L^f^astructure created
I. .Buildings; -
J
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i)Sub Centre buildings
694
ii)Other
Buildings
t
97
(ANMTCs, DH & FW Offices and F "
F.P.Annexure to
selected PHCs, Population Centre
------- j buildings)
iii)Compound walls constructed to Health
Institutioi
- 417
II. Water Supply;- 784 Buildings
III.Vehicles: - Vehicles provided - 111
IV.
Equipments: - Bquipmentssupplied of Rs. 120
lakhs.
India Population Project-in
J
The project was implemented in six districts
of Northern
Karnataka (except Uttar
Kannada and Bellary Districts).
The
project was implemented during 1984-92 with financial
assistance
Of Government of India and International Development Agency(IDA).
The cost of project was Rs.77.31 crores.
. . .2. . .
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Objectives;- Generating demand for services,
- Augumenting staff and facilities, .
- Improving professional and Technical services
- Improviiig Management
- Involvement of community. Voluntary Organisations
Other Government departments and local bodies in
Family Welfare Programme.
The project was implemented by the Project
Co-ordinator
with support of Health and Family Welfare department
and other
departments.
Infrastructure created:-
J« Buildings:-
i) New buildings constructed - 2344
(Subcentres, secondary Health centres, ANMTCs &
LHVTCs, & HFWTCs).
ii)PHC Repaired/Extensions - 83
II<Safe drinking water supply:- 720 Buildings
III. Compound walls constructed:- 654 Buildings
IV. Transport:-
i)Four wheeled vehicles - 154
ii) Two wheeled vehicles
to MOs/BHEs Of PHCs
V. Equipment & Furniture Purchased and
.supplied' to Hospitals/pHCsT
512
-Rs. 260 lakhs
VI. Training of Medical Officers and Para Medica1 Staff PHCs:-
The IPP-lll was implemented by construction Wing, An
implementing wing and an IEC Wing headed by the Project Co-ordi-
nator cum Ex-officio Additional Secretary to Government.
Lacunae in implementations:DDelay in implementation of Project experienced in both projects,
prolonging the project period from five to seven years.
2) Delay in.deputation of staff from other government departments
and appointments.
3) Delay in construction of building due to making the PWD, Land
Army Corporations, Karnataka Construction Corporation responsib-i
for constructions.
4) For obtaining sanctions from Finance and Planning in addition
to approval in P.G.B. due to lack of clarity in theproject
management at different levels.
5) Delays due to conflict between project staff and Department
Officers implementing the Programmes.
INDIA POPULATION
5
-Project _ IX(K)
IPP-IX(k) is implemented
-1 n the State
from 1994
Government of India
an<3 I.D.a.
The ipp^j'•<asi implemented
In Bangalore Division
Districts and IPP-uj
in the Districts
of Belgaum and
Gulbarga
Divisions.
Both the
projects covered
almost 70% population
°f the State
and both
the projects focussed
around health and
family welfare
there were some
though
differences in the
emphasis on service
components.
The Ipp.IX(k) is
implemented in 13
Districts
le. Districts
the State
°f Mysore Division,
Shimoga and
Chitradurga of
Bangalore Division,
Bellary, Gulbarga of <
Culbarga Division
and
Bijapur. Belgaum,
Utt ar a 'Kannada of
Selgaum Division
as for
Ci vil component is
concerned, the iec and
Training component
is implemented
in 20/27 Districts.
th assistance of
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The estimated
cost of Project is
Rs. 122.09 crores.
Project period
is 1994 to 2001.
The
Project Objective*.
The specific objective of the
7
Project is to implement
a programme sustainable
at village level to reduce
crude Birth
Bate, Infant
mortality rate and Maternal
Mortality Rate and
increase couple
protection rate to reach
National Target for
the year 2000 AD.
I
1990
1. Infant Mortality
2. Maternal Mortality
71
3. Crude Birth Rate
4 . Couple Protectio
28
n Rate
6
47
1998
50
2
20
60
.Strategy adopted
for achievine
the objectives:
1. To involve the comnmnity m
family Welfare service/
promoting and delivery of
2, To strengthen delivery of services by
^Equipment Kits and supples to TBAs.,providing:
Subcentres and PHCs.
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b) Make ANMs at subcentre mobile by providing loans
(Interest free) for purchase of Two wheelers.
c) Buildings for subcentres with provision of residential
accomodation for ANMs.
d) Buildings for PHCs.
e) Residential quarters to M.Os.
f) Construction of Training Centres.
3. improve the quality of services by providing training to
personnel. official and non-official at various levels
including TBAs, Conmunity leaders and voluntary agencies.
4. Strengthen monitoring and evaluation by developing and
installing MIES from District to State level.
No.of Buildings proposed for construction under the Project:
1. Sub-Centres
2. P.H.Cs.
3. Quarters for M.Os.
4. Training Centres
1039
94
271
28
Components of Project:1. Strengthening of Service Delivery
A. Buildings;i)New Subcentrex buildings construction
ii)New PHC buildings construction
iii)M.O. Quarters building construction
iv)Rehabilitation of C.H.Cs. P.H.Us. and subcentres.
B. Furnitures:
i)New Subcentres
ii)Other subcentres
C. Equipment:
i)New Subcentres
ii)Other subcentres
iii)Kits for ANMs
iv)Delivery Kits
D. Revolving fund for purchase of Two wheelers for increased
mobility of ANM/LHV.
2. Improving Quality Service:i)Construction of Training Centres
ii)Sanction of SIHFW and District Training Centres
iii)Rehabilitation of existing training centres
iv)Training of M.Os & paramedical staff of PHCs for improve
meat in knowledge and clinical skills.
....3. .. •
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3. -Ip^ormation,
Educationj and
Communication:IEC Equipments, Printed materials.
films and vehicles e tc,
4. MIESComputers to be supplied
to Dlstrict3.
5. Innovative Schemes:-
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Implementation of Project:The IPP-ix(K) project is implemented
>
Project Director cum Ex-Officie Additional
ble for the implementation of project.
from 1994.
The
Secretary is responsi-
He is providedtthe
following staff.
Director,
'4
SIHFW
Project Director cum
» E/0.Add1.Secretary,, IPP-IX(K)
Join£ Director
IPP
ANNEXURE
I
C.A.O.
S. E.
4
Dy.Director
MIES
Dy.Direc^c
I EC
: Equipment for ANM Kit
)
A1JNEXURE -II
: Furniture and Equipment for Subcentre.
Appended
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: ANNEXURE
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EQUIPMENT FOR A.N.M . KIT
Si.No.
1.
2.
3.
4.
Item Description
Quantity
Sphygmomanometer aneroid 300mm with cuff
Colour coded weighing scale (baby)
Instrument sterilizer SS 222 X 22 X 41 mm
Spring type dressing forceps -stainless
steel
5. Basin Kidney enamel 825 ml
6. Sponge bowl- stainless steel
6G0 ml
7. Urethral catheter (12 fr) runner
8. Sheeting plastic clear vinyl 910 mm wide
9* Enema can with tubing
10. Clinical thermometer oral (dual Celsius/
Fahrenheit scale)
11. Clinical thermometer rectal(dual Celsius/
Fahrenheit scale)
12. Brush surgeon's white nylon bristles
13. Mucus extractor
14. Artery Forceps
15. Cord cutting scissors
16. Cord ties/rubber bandpacket
17. Nail clipper
18. Foethoscope (stethescope Foetal)
19. Surgical_scissors straight stainless steel
150 mm
20. Spirit lamp with screw cap: metal (60 ml)
Aluminium shield for spirit lamp
Poly urethane self sealing bag (125 X 200mm)
Arm circumference scale
Rack Blood sedimentation Westergen 6-3/4
unit
25. Adhesive zinc oxide tape(25 mm X 0.9 m)roll
26. Tape measure 1.5M/60H wide vinyl coated
21.
22.
23.
24.
27. Flash light pre focused - 2 cell
28. Kit bag
01
01
01
01
01
02
01
02
01
01
01
01
01
02
01
01
01
01
01
01
01
12
01
01
01
01
01
01
3
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. ^nnexuRe .r. II
FURNITURE anp EQUIPMENX
FOR SUB-CENTRES
buiidiS9£i
1, Furniture for new
Ruantity
n^scriptiQB
Item
SI. No.
01
Examination tabiQ
01
1.
Foot
step
01
2.
with stand
Wash
basin
01
3.
Stool
4.
o1
cot with mattress
02
5.
Bench for visitors
02
6.
and supplies
cupboards for equipment
01
7.
Office table , , .
01..
8.
Side rack
02
9.
Chairs
01
10.
storage
container for water
02
11.
Bucket with lid
12.
Sub-centresj.
2. Equipment for all
Quantity
re
script
ion
Item
SI.NoMetric/Avoirdupois:
01
1 Scale Bathroom
120 KG/280 LB
01
,
i
avhs X 20G
Metric
16KGS
05
2. Scale infant
scale (baby)
coded
weighing
02
3. colour
825 ml
enamel
4. Basin Kidney
01
namel 6 litres
solution deep e
5. Basin
instrument/dressing with cover:
01
6. Tray •
19
5
x
631
mm
02
310 X
clear vinyl 910 numwide
7. Sheeting plastic
02
white nylon bristles
8. Brush surgeon s
01
Needle) straight 7 5^
(Hedgedorn
01
9. Lancet
m wide vinyl coated
measure 1.5 M/60
01
10. Tape
focused .• 2 cell
11. Flash light ore
300 mm with cuff 01
(©manometer■ aneroid
01
12. SphygmBianural
13. Stethoscope
spring type 150 mm
01
14. Forceps dressing
stainless steel
140 mm
straight Kelly
02
Forceps
hemostat
15. stainless steel
(utility)200 mm
01
16. Forceps sterilizer
Vaughn Crim
0.945 litre
01
jar dressing w/cover
17 . stainless steel
uterine vulsellum
01
18. Forceps xXBmtxixM
and
above
250
mm
straight J
P.T.O.
'.v'- . ■'
I
i
•Pniea t for all
i
I
1
./
I
sub-centres
(Contd..)
^issors surgiCai
stalniess
straight Ko
steel
"W S/B
20.
Speculum
Vaginal
s
taihi
stainless
steel Bi-valve cusco's Medium
21. Reagent
strips for
sugar)
urine test
(albumen
22.
and
Sedirl,entatlon
Ostergren 6_3/4
23• Cusco's
& Slms vaginaI
24.
Anterior vaginal wall speculum
25. Measure
retractor
26. Uterine ?^/2 and i litre
sound
27.
SSt SaItl
^Piete
01
01
100
01
01
01
•01
01
01
J
• i
■ i
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Overview of
Karnatak .1 Health Systems Development Project
- Dr. G.V Vijayalakshmi'
India
al ,br“ 1'«1' namely
hMl'b »n.1ces
Pr°V“le
the s[a[e
o Primary
7. Secondary &
D- Tertiary.
>
"z^X“"xterab,e r””°"and -
ov.»
- —d resources through the State’s
’'"“v HoSpitab are fairly rCell develo ’ d in
1"Sb
vanous IPP projects So
m the State with their attarh^
Karnatai<a with r
-i more than 19 Medical Colleges
secondary level of-heath care hith 0Sp'tals are being utilized for
clinical facilities. Whereas
Or India and the World Bank authoXeT^h^
recoSnised
now by the Govt.
reject aims at improving the infrastructure and mod
SyStems Development
-ces by tne seconda. level hospitals bas^
taZ iiT
ytaL and It vanes m different areas of the State
XV"d
T7
f SerV'CeS P^ded by these
being recognised
r
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id Ma.
"
2 covers
KHSDP covers 201 rural Hospitals
107 of which are
ars Communi
subdivisional Hospitals and 74
--nity Hospitals or CHCs in 4
divisions
of Karnatak.
which is; cove'ed under kfw project.
a ^P1 the Gulbarga Division
Land Marks
Pre Project Activities
;■ Preliminary Project / Project Plan
J- workshop
• Project Preparation Committee
* Norms for Hospital facilities & Services
huh level Committee
^BB.S..\[D.FICS
Conslll[;lnl,
B;]ng;i|ore
Dec 1994.
■Ian 1995
28lh Feb 1995
to 1st March 1995
/
Project Preparation Committee was headed by Nir.Sanjay Kaul, IAS, Additional Secretary
for Health with Dr.S.Kantha, Director of medical Education, Dr.M.T.Hema Reddy, Director
of Health & FW Services and other various Additional & Joint Directors of the department.
Establishing Norms for Hospital Facilities Sc Services Committee was formed by various
working groups namely,
1. Medical
2. Surgical
3. Diagnostic Groups.
Medical Group was comprised of
a) Physicians - HODs of Medical Colleges and leading Physicians of Private sector.
b) Cardiologists from Jayadeva Institute of Cardiology, Bangalore
c) Neuro Physicians &. Psychiatrists from premier Institutes
d) Paediatritians from Medical College Hospitals.
e) Forensic Medicine expens
f) Expens in Preventive Medicine
g) District Surgeons
h) Physiotherapists
i) Chief Nursing faculties.
Surgical Group formed a huge working setup headed by a clinical expen with wide Hospital
experience and Administrative Officer supported by
a) General Surgeons
b) Obstetricians & Gynaecologists
c) Onhopaedic Surgeons
d) ENT Surgeons
e) Ophthalmic Surgeons
f) Dental Surgeons
g) Anaesthesiologist
It also included Super Specialists like
a) Urologists
b) Thoracic Surgeons &
c) Neuro Surgeons &
d) Representatives from Operation Theatre Nursing and Nursing Superintendents.
Apart from this it included
a) Bio-Medical Engineers,
b) Health Equipment Specialists &
c) Training expeas from ASCI. Hyderabad
Dia^nostie Group which included
a) Pathologists & Bacteriologists.
b) Radiologists & Sonologists.
c) Bio-Chemists
d) Micro Biologists
e) Laboratory service Experts
9 Senior Technicians &
g) Nursing Assistants from Govt. & Private
sectors.
Simultaneously different Sub-Committees with various
' r
teams v.sited various Hosp.tals of different categories^n the
and the
Teaming Need Assessment). The teams studied hf" the. State for KTNA study (Rapid
Nonclimcal, Diagnostics, Pharmacists & Hospital Mana-em^'train’ng Clinicah
the workshop there were observers from the Wodd Bank d
aSpeCtS' Through out
Punjab & West Bengal
‘d Bank and Officers from other States of
J
All the Committees submitted their repon to the Govt.
Sept 1995US th£ 51111 Pr°jeCt ProP°saJ of KHSDP
was submitted to the World Bank in
the
Minister1 XT^H^Dev^Cow^o^
Ex.Prime
“T0TX‘ronJ:
TSTby “
T Health Secretaries from Govt, of India
&
, IAS, Project Administrator ofKHSDP & E/o Secretary tQ
He^th
project activities in various phases.
°
o^ireetorat. of
S USS the ImPIenientation of the
Salutations and ;
remembrances to the following Officers
& Officials who worked for
Pre Project activities &
: preparation of Project Proposal.
>
I’
ealt\Srreta^ t0 GoVt °f K™ka
4. Innumerable Officers of various cadres of Clinical Adm'
■
sections of Health Dept
^“nical.. Adnumstration, Statistical
3
k /
Implementation of the Karnataka Health Systems Development Project (KHSDP)
KHSDP office has been established in the premises of Public Health Institute Buildinu
on Seshadri road, KR Circle, Bangalore-1.
To insert Sn. B. Eswarappa, IAS, Secretary to Govt., Health &. Family Welfare
Dept., Project Administrator & E/O Additional Secretary to the Govt, of Karnataka
Dr.S.Subramanya, IAS. heads the entire Project team. He is assisted by Chief Administrative
Oiticer, Chief Financial Officer, Under Secretary, etc., with their respective teams
Two Bio-Medical Engineering consultants provide technical assistance in procurement
ot Hospital equipment and Training programme for the technical assistants for repair &
maintenance of equipment through out the State.
Civil wmg is headed by the Chief Engineer and assisted by his team of Superintendent
Engineers, Executive Engineers, Asst. Executive Engineers, Asst. Engineers, Junior Engineers
etc., along with other ministerial staff.
Deputy Chief Architect heads the team of Architects in preparation of plans, etc., for
construction of Hospital Buildings with technical emphasis.
Medical Wing constitute of
1. Additional Director (Strategic Planning Cell) assisted by his team & consultant who
evolves Health Sector strategy, coordinates Health Sector planning and conducts
research studies.
2. Additional Director (Medical) is supported by the Project Consultant and a team of
Joint Director &, four Deputy Directors to look after all aspects of infrastructure of
201 Hospitals regarding space norms in planning, Operation Theatre design and
Equipment installation, etc.,
The major component is the training programme ’which includes clinical training for
General Duty Doctors and Specialists in various disciplines to upgrade their clinical
skills.
°
a. State level training for Trainers of Trainees(TOT) or Master Trainers by the
JIPMER, Pondicherry team and St. John’s Hospital, Bangalore.
b. District Level training of the Taiuka level Hospitals and CHCs by the TOTs in the
District Hospitals.
c. Specialists’ training at super speciality Hospitals under taken at
i. Jayadeva Institute of Cardiology
ii. Indira Gandhi Institute of Child Health
iii. Trauma Care training at HOSMAT & Mallya Hospitals
iv. Neurology, Neuro Surgery &. Psychiatry at NIMHANS
v. Laparoscopy
Foetal Monitor Tocography at MS Ramaiah Medical
College Hospital &. Vani Vilas Hospital, Bangalore.
\ /
varin
train,n* Programmes will be funher
various other disciplines.
Driver
^urses Gaining is undertaken
Pr>vate sector through out the state.
extended in other premier institutes for
at major District level
Hospitals in Govt. and
tn h r Pharmacists training starts with state level
training with the trainers from 29-12-1997
o owed by District level training of the Pharmacists all
over the State.
Laboratory Technicians
-dnc^pSc
SS)’ ^2^“™'°^' & Ctai“'
or Water is
*
Cumulative Status report of various training corhponents are as follows
SamiAWIEALTH systems DEvn npjMHmBQjECT. BA
r „„
Training Status as on 31-03-1997
)
Trained
istnet Level Training to CHC/Taluk Level Doctors
82
20
11
J
Training Status as on 31-10-1997
1.
~
1 raiTOrs Training at St.John's Medical College, Bangalore (Doctors'!
Masters Trainers^Traini'
J
PH'Wi,er ,eS,i"S-
Nurs’
6.
t0 EcluiPment Maintena;
•nee Wing at
7. One day Workshop in Hospital Waste Management
8.
9. Trainin! In ?n,hoPaedicians at Sanjay Gandhi Hospital, Bangalore.
10. Trai • ~ dl iatncians at Indira Gandhi Institute of Child Health
HyderabadTeChniCianS
Trmng to Physle|MS in Iccu „ s„
^XSiology.
26
20
101
15
J 88
36
20
03
12
13
Cumulative Training Status as on 15-11-1997
-■ Mas^TrannTf-r' St J°hll’S Medical College, Bangalore (Doctors)
)
gorier Lece! Trait
)
Nursi
108
40
I 12
15
249
PH. in Ware, testing.
' HydTaba^ TeChniCianS
t0 EcIuiPmen£ Maintenance
Workshop
in Hospital Waste Management.
I 3JOne
f daysdayconference
in
Trauma Anaesthesia &. Critical Care
Wing at
36
20
20
5
/
//
9 Training to Orthopaedicians at Sanjay Gandhi Hospital, Bangalore
10. Training to Pediatricians at Indira Gandhi Institute of Child Health
1 I. Training to Physicians in ICCU at Sri.
Jayadeva Institute of Cardiology
12. Training of OBG specialists
13 Training at NIMHANS for Doctors
Psychiatry
Neuro Surgery
Neurology
Status Report on Civil Works as on 10-11-1997.
Total No. of Hospitals included in the Project
No. of Hospitals so far assigned to Architects
(No. of Architects involved 46)
No. of Hospitals for which Preliminary designs are cleared by World
Bank
201
190
90
Present Stage of these 90 Hospital;is
Works awarded after bidding
Works taken up under force Account
Bids sent to World Bank for Clearance
Bids sent to World Bank to clear Re-Bidding
Bids under evaluation
Bids advertised
. *
Bidding documents awaiting approval of World BanU
Bidding documents being sent to World Bank for Approval
Estimate under finalisation
Estimate yet to’be received from Architects
Total
31
05
01
01
12
03
04
02
05
26
90
Preliminary design cleared by WBA but communication from WBA
awaited
Preliminary designs reviewed by the World Bank Architect on 10/97
and cleared subject to modifications to be verified by BSC.
Preliminary designs reviewed by the World Bank Architect and to be
reviewed by him after modifications are carried out.
Preliminary Designs under preparation, etc.,
No. of Hospitals yet to be assigned to the Architects
69
11
Grand Total
201
01
26
04
03
I1
IS
05
04
02
02
Objectives of the Training Prosramnie
Primal' objective of the training component is to improve quality and strengthen the
services provided at first referral facilities i.e„ CHCs.
'
en^tnen the
Main objective ot the Hospital Management training is to strengthen management
knowledge and Hospital Admimstrator skills. The intention of the Management traimmXt be
“n,"s ,o Mh“ce ,h'awity °f
X-p
J
Management training has been focused on
1. Facility Management
2. Personnel Management
Recruitment procedures
Rules and regulations
Supervisory Techniques
Disciplinary Procedures
Motivation
Team building
Group Dynamics
Training &. Development
3. Maintenance
Planning for preventive maintenance
Maintenance of Buildings
House keeping
Monitoring of use and abuse
Hospital / Medical waste management
4. Finance
Govt, financial procedures
Budget Planning
Procedures & Practices of Accountins
System
Budget monitoring and control
Internal Audit &.
Management of User charges
5. Procurement Matters .
J
6. Consumable
management
supplies
7 Information System
J
to 6ee: j'y
Procurement procedures, rules & regulations
including
Drugs
Planning for the supplies
Procurement
Inventory management
Usage
Monitoring the storage
The use of information to improve Hospital
Management
Importance of Patient’s registration
Medical records &.
Medical reporting
7
8. General Issues
Role of Secondary level Hospitals in
supporting Primary level facilities and referral
system
Role of advisory committees
Relationship of the Hospital with the
community
Referral System
Introduction. Health care in 3 levels
Primary
Basic Health Services
Preventive &. Promotive aspects
Family Welfare & MCH
Sanitation, etc.
Secondary
CHCs with updated bed strength of 30, taluka
and sub divisional Hospitals with updated
beds of 50-100 & District Hospitals with beds
250-800.
These Hospitals provide Outpatient, Inpatient
care & diagnostic facilities.
Also carryout various National Health
Programmes and these Hospitals come under
the control of DH & FW Officer.
Tertiary
Teaching Hospitals with more than 500 beds
provide specialised services and these
hospitals come under the control of Director
of Medical Education.
QUALITY MEDICARE
can be provided only when a
PROPER AND EFFECTIVE REFERRAL SYSTEM
IS FORMULATED AND IMPLEMENTED .
Current Referral System:
No definite system is existing
PHCs
CHCs
Tertiary
- Inadequate quality of services.
- are often bypassed
- are unnecessarily overburdened.
3
8
Ncnv referral system:
Renovating and upgrading of Hospital Buildings to provide appropriate space services.
• Upgrading and Updating clinical skills of Medical Officers and Nurses through an effective
training programme.
• Providing Ambulances for transporting critical patients.
&
• Installing Phone, Fax / Radio communication.
CHCs will become the
Referral Points for Primary Health Care Level
)
Referral System under KHSDP:
)
• Provides correct line of treatment with each category of hospital as per the service matrix.
• Patient is encouraged to use Primary and Secondary Hospital facilities before optin^ for
tertiary Hospital.
°
• A Referral Card is used whenever a patient is referred.
Measures contemplated are
)
• Referral and feedback cards are being introduced
Referral Guidelines that specify the When & How of implementing the referral system are
provided.
• Incentives for patients who follow referral systems is envisaged.
• Linkages
Communications between the First. Referral Hospital &. primary care facilities
through regular training and outreach visits are being established.
Intensive DEC targeted at providers and the community has been initiated.
District Health Committees will monitor the implementation of Referral System.
Referral Network:
• Zoning of each District
:*
• Referral Chain -
>
PHC
CHC
TqH/ SDH / DH
.
TH
9
Referral Maps:
Map 1: Villages, Blocks, Towns & Cities.
Map 2: PHC, CHC, SDH &. TH and important NGO unit.
Map 3: Roads, Rivers, Police Station, Post Office, etc.,
Facilities for transport of Patients:
Guidelines:
1. Patients are charged only actual fuel cost.
2. Payment collected by office staff identified by the Medical Officer / Superintendent
of referring Hospital.
3. Additionally the driver of the Ambulance will be provided with a receipt for
collection of charges if a patient needs further transport if advised by the referred
hospital. In such a case the driver should deposit the amount in the original hospital
on return.
4. Critically ill and poor patients may be exempted from paying Ambulance fee
depending on the situation.
5. Ambulance service to be provided as and when required.
6. Telephone Nos. of Hospitals to be indicated so that during emergencies oral
communication can be resorted.
Operationalisation of Referral System: ex. Pilot Chitradurga District Hospital.
Use of Service Matrix - Referral Protocol.
X
10
Receiving of the Referred Patients
Place Earmarked
1. Queue Jump / Treated on priority.
2. No OPD ticket. Referral Card itself is used as OPD ticket.
3. Feed Back Card - .All information regarding treatment at referred hospital return with
follow-up treatment to the referring doctor. .
4. Provision of low cost transportation - In emergencies, when no alternative is possible, cost
will be reimbursed by KHSDP through the District Surgeon.
Accommodation of Patient parry in referred hospital in the rest house may be arranged by
the Medical Officer if there is any such facility.
Implementation Plan:
Overall responsibility:
• Additional Director (Medical) at State level for necessary Gos, providing funds / cards,
procurement, etc.,
• Funds for implementing the Project will be released by the Project Administrator through
the District Surgeon.
J
District Referral Committee: will be setup with
• District Surgeon,
• DH&FWO,
• TMO,
• RMO &
• MOH as members.
The Committee ensures the functioning of referral system as contemplated in service matrix.
Any additional requirement / clarification - may seek the instructions from the Project
Administrator, KHSDP.
Referral Training Programme-, is organised by District Surgeons for all categories of staff
working in all the Hospitals & PHCs in the Districts as per needs.
District Surgeon sends monthly repon to the Additional Director (Medical) and Project
Administrator of KHSDP.
J
Any technical suggestions from senior officers of DH&FW may be taken into account bv the
District Surgeon.
II
\ /
ReferrdI Procedure -
Not Passing the Buck
1. Referral register has to be maintained.
2. State reasons for referral and patient to be informed properly
3. Stabilize general condition of the patient & transfer when required
Referral System is only a
Tool to provide best Medicare
and
Not Shirk Responsibilities
4. Non-emergency / cold patients should make own rarrangements for transport. But
information and broad guidelines are to be given and they are t’reated in regul’ar’oPD hoJrs
Critically ill patients / emergencies
are attended Round the Clock
On-duty Medical Officers are empowered to make reference to hieher hospital following the
referral procedure.
omen - Extended RCH Programme.
Interventions contemplated under RCH project mainly relate to maternal health.
Recent literature points to the urgent needs to address other aspects of women health which
go beyond her role as “ Mother
Women’s low social status and reproductive role expose them to high health risks.
Women’s health is an important concern as it affects the next generation and her productivity
in economic activities.
Special attention is required to reach females during adolescents and reproductive and
other life style behaviors set the stage for later life. Hence women’s health should be viewed
through ‘ Life-cycle Approach ’ because many problems that affect women’s reproductive age
and her new bom and in her old age - All begin in childhood & adolescence. Towards this end
during the project period a range of expanded services under the Extended RCH programme
are proposed to be introduced both with and without project interventions.
In the first Phase
1. Promotion of positive health practices such as personal hygiene especially during
menstruation, adequate nutrition etc.,
2. Screening for and treatment of reproductive tract interventions and sexually
transmitted diseases.
I2
k /
Screening and treatment of Gynaecological problems such as
a) Menstrual irregularities
b) Fibroid uterus
c) Ovarian Tumors.
d) Prolapse Uterus.
>-
e) Pelvic Infections and other common conditions.
4. Screening & Treatment of Cancer
Cervics
5. Increased policy dialogue and strategic efforts to reduce render w ■ • •
violence through “ Engendering & Empowerment ”.
discrimination and
Phase.
)
Additional interventions are-
7-
°"S"
- MMOpause.
8. Prevention & treatment of infertility.
•>
which aLhemtOhVV=ZVtVe7corehofV'h”T*"'
primar,' heaith cap/Zcnb^l
assistance.
Y
)
Wring in.crven.ions
support to the
technical. services referral services and financia!
The programme covers all the women fmm in m
suspected cases for each tvoe of distZ- / 2'
yearS' The
wiU identify
>
)
13
Role of Doctors in Implementing Project
Activities and their responsibilities
• Doctors
Implementing Project Activities
• Moral Responsibilities
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NUTRI
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TERTIARY
CARE
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I
I
SEX
EDUCATIUON
HEALTH
& MEDIC
AL EDU
CATION
I
I
HEALTH
ECONO
MICS
POPUL
ATION
CONTROL
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HEALTH
CARE
SOCIAL
MEDICINE
INTEGR
ATED
RESEA
RCH
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V /
CH9CD HE/LC^cH SERVICES
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THE PAST :
ri^ri0^er 3? years Family Welfare Programme was known for its
rigid, target based approach in contraceptives. The performance
m tnLea^red by the reP°rted numbers of the four contraceptive
|
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J
--------------- Dr. G.V. Nagaraj*
pills and Condoms,
his was widely criticised for being a coercive approach.
IO
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f
• . .
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The 1994 Cairo International Conference on Population and
Development (ICPD) formulated a growing International consensus
hat improving reproductive health and family planning is essential
to human welfare and development.
A 9rowing body of evidence and the Cairo consensus suggest
Numerical method specific contraceptive target and
monetary incentives" tor providers to be replaced by a broader
system of "programme performance goals" and measures
focussed on a range of reproductive health services.
ennfr? I
rePort-1995 concludes that, .the current
contraceptive Target and Incentive" system gives a demographic
anr.thof9 ®mPha^,s t0 fami|y welfare programme (FWP) which is
antithetical to the reproductive and child health (RCH) client
for tT raPPrOaCh/dVOCated in the GOi-lcpD country statement
tamlt -Cair0 conference- ln Particular emphasis on numerical
client n-^H3 ma!Or reason f°r
lack of attention to the individual
dent needs and is detrimental to the quality of services provided.
J
MdSS. DPH (Cal). PGDHM. MD, Ml PHA
project Director (RCH),
taL fw {Bureau, Ananda Rao Circle. Bangalore 0 560 009.
-2-
Family Welfare Programme to Reproductive Child Health
-The paradigm shift:
To date the impact of Family Welfare Programme has been
measured in terms of their contribution to increase contraceptive
prevalence and to decrease fertility. These indicators are
inadequate for measuring the impact of reproductive Health
Programme and therefore, new indicators for monitoring
reproductive health services and "Service Quality" from the
perspective of the client are urgently needed.
Over the past decade there has been ai clearer articulation and
definition of reproductive health as a concept and some thinking on
the ways in which reproductive health problems should be
addressed.
Against this background the main recommendations of the World
Bank report on the Indian Family Welfare Programme (FWP) is that
the programme is to be re-oriented expeditiously to a Reproductive
and Child Health approach (RCH). The main objective of which
would be to meet individual client health and family planning needs
and to provide high quality services.
The principle goal of a reproductive health programme is to
" Reduce unwanted fertility " safely there by responding to the
needs of the individuals for "High quality health services" as well
as to the demographic objectives.
The report recommends that the targets be replaced by a broad set
"male
of performance goals and greater emphasis on
contraceptive methods" especially vasectomy and condoms
and greater choice of methods^--------------- ;--------------------- '■’Government goals for family planning should be defined
terms of unmet needs for information and services.
Demographic goals should not be imposed in family planning
providers in the form of targets or quotas"
|
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-World Bank - 1995
i
-3-
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The trend of health programme should change from a "Population
Control Approach" of reducing number to an approach that is
"Gender Sensitive and Responsive" client based approach of
addressing the reproductive health needs
— of individuals, couples
and families.
Reproductive Health Programmes should airrTTo reduce the
burden °f unplanned and unwanted child bearing and related
morbidity and mortality.
What is reproductive Health ?
The-1994 Internationa1 Conference on Population and Development
at Cairo (ICPD) has indicated a consensus definition as a "State of
complete physical, mental and social well being and not merely the
a sence of disease or infirmity in all matters relating to reproductive
system and its function and processes"
Reproductive health approach means'th a t
I
People have ability to reproduce and regulate their
fertility.
Women are able to go through pregnancy and child birth
safely.
The outcome of pregnancy is successful in terms of
maternal and infant survival and well being and
Couples are able to have sexual relation free of the fear of
pregnancy and of contracting diseases.
(Fathallah-1988)
The reproductive health ;approach' believe that it is linked to the
subject of reproductive rights and freedom
------- 1 and to women status and
empowerment. Thus it extends beyond the narrow confines of family
r/\en
?ZmpaSS 3,1
encompass
all aspects of human sexuality and
p oductive health needs during the various stages of life cycle.
4
■7 O
X
a
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Reproductive health programme is concerned with a set of
Specific Health Problems
Identifiable cluster of client groups
Distrinctive goals and strategies
The programme enable clients:
To make informed choices
Receive screening
Counseling services
Education for responsible and healthy sexuality
Access services for prevention of unwanted pregnancy
Safe abortion
Maternity care and child survival
Prevention and management of reproductive morbidity.
Implementing reproductive health services means a change in
the existing culture of the programme from one that focuses on
achieving targets to one that aim at providing a range of quality
services.
5
Objective of RCH packages are :
1. Meet individual client health and family planning needs.
2. Provide high quality services.
3. Ensure greater service coverage
RCH Policy :
The fundamental policy change is that Instead of remaining
responsible for reducing rate of population growth, reproductive
health programme would become responsible for reducing burden
of unplanned and unwanted child bearing and related morbidity and
mortality.
Furthei the basic assumption is that improvement in service quality
will result in client satisfaction and will over long term translate into
higher contraceptive prevalence and ultimately fertility regulation. By
providing good quality services the programme will be able to
achieve the objective of not only reducing fertility but also reducing
reproductive morbidity and mortality.
New Signals :
Shifting to reproductive health approach implies changing the
implementation signals. :
Client satisfaction becomes the primary programme goal
with demographic impact a secondary though important
concern.
Broadening the service package is necessary
improving service quality becomes the top priority.
c
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The new signals for a quiet revolution in the way the programme is
planned and managed are :
Primary goal
: While still encouraging smaller families
help Client meet their own health and
F.P. needs.
Priority services : Full range of family planning services
Performance measures
Management approach
Attitude to client
Accountability
: Quality of care, client
satisfaction, coverage
measures .
Decentralised, client-needs
driven, gender sensitive
: Listen, assess needs, inform.
: To the client and community
plus health and F.W. staff.
Reproductive Morbidity and Mortality :
1/3 of the total disease burden in the developing country of
women 15-44 years of age is linked to health
problems related to pregnancy, child birth, abortion,
HIV and Reproductive tract infections (RTI's).
The heavy load of reproductive morbidity among Indian
women is an outcome of their:
1. Poverty
2. Powerlessness 3. Low social status
4. Malnutrition 5. Infection 6. High fertility
7. Lack of access to health care
India's maternal mortality ratio, usually estimated at 400500 per 1,00,000 live birth is fifty times higher than that in
the developed countries.
In India a small study has revealed that for every women
who dies, an estimated 16 others develop various risks.
Chronic and debilitating conditions such as vaginal
fistulas and uterine prolapse cause terrible suffering.
7
CHJLD_SjJRyiVAL AND SAFE MOTHERHOOD PROGRAMME
TO
’———
B-EPRODUCTIVE and child health services
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Implementation of a very important, massive and highly credible
UIP programme from 1985 to 1991 throughout the country has
made a break-through in the improvement of mother and child
health services. In spite of this, compared to developed countries,
our country is still lagging behind in respect of sensitive indicators
such as infant mortality rate and maternal mortality rate.
Looking at the perinatal mortality which contributes 50% of the
infant mortality rate and also one mother dying out of 250
pregnancies, it can be concluded that immunization alone is not
adequate and will not be able to bring down these death rates.
Hence along with the immunization programme, a package of
services named "CHILD SURVIVAL AND SAFE MOTHERHOOD"
was implemented with the World Bank assistance from April-1992
to September-1996 in all the states.
The main objectives of CSSM programme are
I
Improvement in mother and child health
Lowering the infant deaths (0 to 1 year) child mortality
(Ito 4 years) and maternal deaths.
-LhejTTckage of services under this programme a re :
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CHILDREN :
1. Essential new born care
2. Immunization (BCG, DPT, Polio and Measles)
3. Appropriate management of diarrhoea cases
4. Appropriate management of ARI
5. Vitamin 'A' prophylaxis
r
MOTHERS:
1' XpfcXT and iden,itotion °f maternal
2. Immunization (against Tetanus)
3. Deliveries by trained personnel
4. Prevention and treatment of anaemia
5. Promotion of Institutional deliveries
7.' BirthZX* °f Emer9enCy ObsteWc Care (EmOC)
THE RCH PACKAGE :
theTe^ormtnce wasmeaT3 'd®ntified as TarSe‘ Free District
on L expeXT^T^^^r
and
indiCateS' Based
the districts in Karnataka
ave adopted Target Free Approach" anu uu
and from Sept. 1997 onwards
of «NmUn
Needs Assessment Approach,
•• The implementation
and m Th 'so ated programmes concentratingJ on Family Welfare
and Mother and Child Health under I'
National
Family Welfare
Frogramme will now be implemented
.
Reproductive and Child Health Servi
’—
’ I’ ‘ as an Integrated
ices which is equivalent to
Family Planning, to focus
on fertility regulation
and
Child Survival and Safe Motherhood Programme
and
★
°f ReProductive Tract Infections and
of AIDS7 mnsniitted Infections and prevention
1
Through
Client Onented/Mother-Friendly/ user - specific
Family Welfare Services
Pecitic,
2
High quality services
\ /
♦
TheHf^?hIC pro9rammes under Reproductive and Child
neairn services are
T Prevention and management of unwanted pregnancies
2. Maternal care
a) Ante-nata! services
b) Natal services
c) Post-natal services
3. Child Survival
4. Treatment of Reproductive Tract Infections (RTI) and
Cexually Transmitted Infections (STI).
Reducing the~"'unmet
'unmet need'
need' increasing
increasing 'service coveraoe'
and
[ensur ing_^ualityof care' will be the focus of implementation
•
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The implementation
various
IpvaIc
1 guidelines of these health interventions at
various levels are detailed in the annexure.
.: 11
ESSENTIAL REPRODUCTIVE AND CHILD HEALTH SERVICES
AT DIFFERENT LEVELS OF THE HEALTH SERVICES SYSTEM
Health
Intervention
Community Level
Subcenter Level
Primary Health
Centre Level
1. Prevention and
management of
unwanted
pregnancy
1. Sexuality and
gender information
education and
counseling
No.1 as in
community level
Nos.1-6 and
2. Community
mobilization and
education for
adolescents, newly
married youth, men
and women.*
3. Community
based
contraceptive
distribution **
(through
panchayats, village
Health Guides,
Mahila Swathya
Sanghas, etc., with
follow-up)
4. Motivating
referral for
sterilization
5. Social marketing
of condoms and
oral pills through
community sources
and G.P. (Oral pills
to be distributed
through health
personnel including
GPS towomen
who are starting
pills for the first
time).
6. Free supplies to
health services
* to be piloted
~ Panchayats to
distribute only
condoms
2. providing * oral
contraceptives
(OCS) and
condoms.
3. Providing IUD
after screening for
contraindications.
4. Conseling and
early referral for
medical termination
of pregnancy.
5.Counseling/
management/
referral for side,
effects, method
related probiems,
change of method
where indicated.
7. performing tubal
ligation by minilap
on fixed dates*
8. Performing
vasectomy.
9. Providing first
trimester medical
termination of
pregnancy upto 8
weeks (includes
MR)
10. Facilities for
Copper T insertion
to post natal cases
11. Treatment
facilities for all
types of referrals.
6. Add other
methods to expand'
choice.
7. Providing
treatment for minor
aliments and
referral for
problems.
* Social marketing
of pills and
condoms through
HW (M&F) may be
explored by
permitting her to
retain the money.
* PHC s should
have facilities for
tubal ligation and
minit lap including
OTs and
equipments
First referral
Unit/District
Hospital Level
Nos. 1-11 and
12. Providing
services for
medical
termination of
pregnancy in the
first and second
trimester (upto 20
weeks) where
indicated.
0
*
ESSENTIAL REPRODUCTIVE AND CHILD HEALTH SERVICES
AT DIFFERENT LEVELS OF THE HEALTH SERVICES SYSTEM
)
Health
Intervention
Community Level
Subcenter Level
Primary Health
Centre Level
First referral
Unit/District
Hospital Level
2.Maternity care
1. Eady registration
of all Pregnant
Women
2. Awareness
raising for
importance of
appropriate care
during pregnancy &
identification of
danger signs
No.1-4 and
Nos.1-10 and
Nos. 1-12 and
5. Three antenatal
contacts with
women either at
the sub-centre or at
the outreach village
sites during
immunisation/MCH
sessions.
11. Treatment of
T.B.
13. Diagnosis and
treatment of
RTIs/STls.
14. Weakly
clincnics for High
risk pregnancies.
3. To mobilise
community support
for transport,
referral and blood
donation
6. Eady detection
of high risk factors
& maternal
complications and
prompt referral
4. Counseling
education for
breast feeding
nutrition, family
planning, rest,
exercise & personal
hygiene etc.,
7. Referral of high
risk women for
institutional
delivery.
Prenatal Services
)
5. Eady detection
and referral of high
risk pregnancies
6. Observing five
cleans or through
Social marketing of
disposable delivery
kits, Delivery
planning as to
where? when and
from whom?
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" The need for IEC
suppod and
establishment of
first Referral
facilities
12. Testing of
syphilis for high risk
group and
treatment where
necessary including
for RTI's.
8. Treatment of
malaria (facilities
including drugs to
be made available
at subcentres)
9. Treatment for TB
and folloup.
10. Preventive
measure against all
communicable
disease
* training of
laboratory
technicians,
equipment and
reagents required
Health
Intervention
Community Level
Subcenter Level
Primary Health
Centre Level
First referral
Unit/District
Hospital Level
Delivery Services
1. Eady
Recognition of
pregnancy and its
danger signals (
rupture of
membranes of
more than 12 hours
duration, prolapse
of the cord,
hemorrhage)
Nos.1-4 and
Nos. 1-7 and
Nos. 1-9 and
5. Supervising
home delivery
8. Modified
partograph
10. Treatment of
severe sepsis
6. Prophylaxis and
treatment for
infection (except
sepsis)
9. Delivery services
11. Delivery of
referred cases
2. Conducting
clean deliveries
with delivery kits by
trained personnel.
7.Routine
prophylaxis for
gonococci eye
infection.
3. Detection of
complications
referral for hospital
delivery.
4. Providing
transport for
referral
5. Referral of New
bom having
difficulty in
respiration
6. Management of
Neonatal
hypothermia
-n
10. Repair of
episiotomy and
perennial tears
12. Treatment of
high risk cases
13. Services for
obstetrical
emergencies
anesthesia,
cesarean section,
blood transfusion
through close
relatives linkages
with blood banks
and mobile
services.
-L3♦
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Health
Intervention
Community Level
Subcenter Level
Primary Health
Centre Level
First referral
Unit/District
Hospital Level
Postpartum
services
1. Breast -feeding
support.
Nos. 1-6 and
Nos. 1-8 and
Nos.1-10 and
7. Referral for
complications
9. Referral to
FRUs for
complications after
starting an I.V. line
and giving initial
does of antibiotics
and oxytocin when
indicated.
11. Management of
referred cases.
2. Family Planning
counseling
3. Nutrition
counseling
)
4. Resuscitation for
asphyxia of the
newborn
5. Management of
neonatal
hypothermia
J
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)
6. Early recognition
of post partum
sepsis & referral
8. Giving inj.
Ergometrine after
delivery of placenta
10 . Management
of asphyxiated new
bom (equipment to
be provided)
PHCs and FRUs
would require
additional
equipment and
training for
management of
asphyxiated new
boms and
hypothermia.
These include a
resuscitation bag
and mask and
radiant warmers.
-yHealth
Intervention
Community Level
Subcenter Level
Primary Health
Centre Level
First referral
Unit/District
Hospital Level
Child survival
1. Health education
for breast feeding
nutrition
immunization,
utilisation of
services, etc.,
Nos 1-6 and
Nos.1-9and
Nos.1-10 and
7. Treatment of
dehydration and
pneumonia and
referral of severe
cases.
10. Management of
referred cases.
11. Handling of all
paediatric cases
including
encephalopathy.
12. Identification of
certain FRU's to
provide specialist
services and
training
2. Detection and
referral of high risk
cases such as low
birth weight,
premature babies,
babies with
asphyxis,
infections, severe
dehydration acute
respiratory
infections
(ARI).etc.,
8. First aid for
injuries etc.,
9. Closing watching
on the
development of
child and creating
awareness of
cheap and
nutritious food.
3. Help during
Immunization by
ANM.
4. Help during
Vitamin ’A’
supplementation by
ANM.
5. Detection of
pneumonia and
seeking, early
medical care by
community and
treatment by ANM.
6. Treatmerrt of
diarrhoea cases
and ARI cases
lb
k >
/-(I
3
3
)
Health
Intervention
Community Level
Subcenter Level
Primary Health
Centre Level
First referral
Unit/District
Hospital Level
Management of
RTIs/STIs
1. IEC. counseling
for awareness and
prevention
No.1 and 4
Nos 1-8 and
Nos. 1-9 and
5. Identification and
referral for vaginal
discharge, lower
abdominal pain,
genital ulcers in
women, and
urethra discharge,
genital ulcers,
swelling in scrotum
or groin in men.
9. Treatment of
RTIs/STIs
10. Laboratory
diagnosis and
treatment of
RTIs/STIs
2. Condom
distribution
3. Creating
awareness about
usage of sanitary
pads by women of
reproductive period
4. Creating
awareness of about
RTI’s and Personal
hygiene
3
6. Diagnosis of
RTI/s and STI’s by
Syndrome
approach.
7. Referral of
Cases not
responding to
useval treatment.
8. Partner
notification/referral
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>
it
10. Syphilis testing
in antenatal women
11.Syndromic
approach to detect
and treat STD in
Antenatal post
natal and at risk
groups
* )
THE PACKAGE OF
REPRODUCTIVE AND CHILD HEALTH SERVICES
Reproductive Child Health (RCH) can be defined as a state in which "People
have the ability to reproduce and regulate their fertility: women are able to go
through
pregnancy and child birth safely, the outcome of pregnancy is
successful in terms of maternal and infant survival and well being; and couples
are able to have sexual relations free of the fear of pregnancy and contracting
disease". This means that every couple should be able to have child when they
want and, that the pregnancy is uneventful and see, that the safe delivery
services are available, that at the end of the pregnancy the mother and the
child are safe and well and the contraceptives by choice are available to
prevent pregnancy and of contracting disease.
The essential elements of reproductive and child health services at the
community and sub-centre level are given below which will help you to
understand how the reproductive and child health services are to be provided
at the community level. The different services provided under RCH programme
are :
I. FOR THE MOTHERS:
’ TT Immunization
Prevention and treatment of anaemia
Antenatal care and early identification of maternal complications
Deliveries by trained personnel
Promotion of institutional deliveries
* Management of Obstetric emergencies
* Birth spacing
' ■
II. FOR THE CHILDREN
‘
Essential newborn care
Exclusive breastfeeding and weaning
’ Immunization
Appropriate management of diarrhoea
Appropriate management of ARI
Vitamin A prophylaxis * Treatment of Anaemia
III. FOR ELIGIBLE COUPLES
Prevention of pregnancy ’ Safe abortion
IV. RTI/STD
~
Prevention and treatment of reproductive tract and sexually
transmitted diseases
)
IMPLEMENTATION of rch programme
IN
KARNATAKA STATE
<>
I) POLICY ISSUES :
*
Reproductive a Child Health Programme will be implemented in the Slate as a
100% Centrally Sponsored Family Welfare Programme during the Ninth Five Year
Plan ending by 2000-2002 A.D.
*
1
State Government has principally agreed to implement and a Government Order
has been issued to this effect (No.HFW 96 FPR 95 dated 17-6-1998).
According to this
*
*
The funds will flow from Government of India through ■State Finance Department'
The programme will be Implemented as a National component and Sub Project (Bellary Dist.)
*
Posts created under CSSM Programme will be continued under RCH budget.
*
The Empowered Committee S a Steering Committee will monitor, guide and solve
the problems of implementation of RCH Programme.
*
The following posts have been redesignated :
Additional Director (FW&MCH) : Project Director (RCH
*
Joint Director (rW)
.Joint Project Director (RCH)
District MCH Officer
:Dist. RCH Officer
Procurement will be done through Karnataka Health Systems
Development
Project.
*
Minor Civil Works to subcentres, Primary Health Centres,
Centres will be done through IPP-IX.
IS
Community Health
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11) FUNDING : A sum of Rs.190.10 crores will be available to Karnataka State during the
Ninth Plan as cash and kind assistance. This includes cash assistance of Rs.15.05 crores
exclusively to Bellary Sub-Project.
11!) CATEGORY OF DISTRICTS : The RCH Programme will be implemented in the State
based on differential approach. Inputs in all the districts have not been kept uniform
because efficient delivery will depend on the capability of the health system in the district.
Therefore basic facilities are proposed to be strengthened and streamlined specially in the
weaker districts as the better-off districts already have such facilities and the more
sophisticated facilities are proposed for the relatively advanced districts which have
acquired capability to make use of them effectively. All the districts have been categorised
into : Category ’A’-3 districts, Category ’B’-11 districts, Category ’C'-B districts.
On the basis of crude birth rate and female literacy rate which reasonably reflect the RCH
status of the State the districts will be covered in a phased manner over three years.
Category wise phasing of the districts and the facilities to be provided are as follows:
RCH PROJECT - PHASING OF DISTRICTS.
YEAR 1
CAT 'A' (2)
(Al) Dakshina
Kannada
(A3) Mandya
CAT 'B' (4)
(B2) Uttara
Kannada
(B10) Belgaum
(B5)
Chikkamagalur
(Bl 1) Dharwad
CAT'C (3)
(Cl) Bijapur
(C3 Bidar)
(C4) Gulbarga
CAT 'A' (1)
(A2) Kodagu
CAT ’B’ (4)
(Bl) Hassan
(B7) Mysore
(B3) Bangalore
. (R)
(B4) Tumkur
CAT'C (3)
(C2) Bellary
(C5) Raichur
(C6) Bangalore
(B8) Kolar
(B9)
Chitradurga
0)
YEAR 2
• (8)
(sub-project)
CAT 'A' (0)
YEAR 3
CAT'S' (3)
(3)
CAT 'C (0)
(B6) Shimoga
< /
h
IV) PROGRAMME INPUTS :
I]
NATIONAL COMPONENT :
Annual Action Plan For 1998-99 has been prepared
1
CONSULTANTS : Five consultants will be hired one each for IEC, MCH,
Administration & Training. Monitoring and Evaluation and Procurement and
Finance.
2.
■J
COLD CHAIN MAINTENANCE : Budget for minor repairs both by State level and
also by District level will be available.
3
CONTRACTUAL STAFF : Staff Nurse will be hired in category ’C’ & ’B’ districts to
the extent of 25% of PHCs in the first year.
4
EMERGENCY OBSTETRIC CARE DRUGS (EmOC) : To bring down the maternal
deatlhs, emergency obstetric Care JDrugs will be supplied to FRUs wherever
cesarean section and other emergency surgical procedures are being conducted.
5
J
ESSENTIAL OBSTETRIC CARE DRUGS: These drugs will be supplied in the
form of kits by Govt, of India during the first year.
6
KITS ‘E’ TO 'P' : These kits were supplied to 68 FRUs under CSSM programme.
Still there are large number of FRUs which are to be equipped during the first
year. 2 districts in ’A’ category, 4 districts in 'B* category and 3 districts in ’C
category will be supplied with ’E' to 'P' kits.
7
——. DELIVERY SERVICES AT PHCs : To enhance the institutional
deliveries, a scheme will be taken up on a pilot basis in Kolar district wherein an
incentive of Rs.200/- to Medical Officer and Rs. 150/- to St^ff Nurse will-be given
who attends night deliveries between 7.00 pm to 8.00 a.m.
8
ESSENTIAL NEW BORN CARE EQUIPMENTS : Essential New Born Care
Equipments were supplied by Govt, of India through National Neonatology Forum
under CSSM programme for few PHCs in Chikkamagalur, Chitradurga and Kolar
districts. Realising that the peri-natal mortality rate is responsible for more than
50% of infant deaths, new Born Care Equipments will be supplied to 10 bedded
maternity hospitals, FRUs/CHCs and Block Level PHCs where there are facilities
such as wards, staff nurse and labour room.
9
IEC ACTIVITIES : A sum of Rs. 15.00 lakhs is available for taking up innovative
IEC
activities focusing
on
behavioural
changes
in
addition
awareness regarding interventions under RCH programme.
to enhancing
-20-
10
VEHICLE : Field staff particularly Junior Health Assistant (F) will be supplied two
wheelers to improve her mobility, accessibility for service to attend emergency
services and also to Improve her Status in public. This facility will be taken up in 7
Non-IPP-IX districts (Tumkur, Kolar, Bangalore (U), Bangalore (R), Dharwad,
Raichur & Bidar).
11
MINOR CIVIL WORKS : An amount of Rs.190.00 lakhs has been made available
to take up minor civil works particularly in the institutions such as Subcentres,
PHCs, FRUs and also training centres.
12
Government of India will be directly
releasing the funds to the
Deputy
Commissioners of the districts to support IEC activities through Zilla Saksharatha
Samithis (ZSS). Each proposal costing about Rs.3.00 to Rs.5.00 lakhs will have
to be formulated by the ZSS and directly sent to Govt, of India for funding.
13
TRAINING UNDER RCH : The State Institute of Health & FW will be dovetailing
the RCH component in the regular IPP-IX
training programme. Awareness
programme for the State Level Officers as well
as District Level Officer will be
initiated . Manuals have already been
made available at all the districts for
undertaking six days RCH training programme for ANM's.
14
IMPROVED MANAGEMENT: Preparation of district plans under Community
Needs Assessment Approach as a Decentralized Participatory planning is under
way. Training programme has been completed in most of the districts.
II. SUBPROJECT :BELLARY:
Annual Action Plan for 1998-99 has been prepared. .
A sum of Rs. 15.05 crores exclusively for Sub Project Bellary has been approved by Gol.
Civil Works
: 5 Sub centres, 5 PHCs & 5 Maternity Hospitals
Equipments
: 174 Subcentres, 10 PHCs, 50 PHUs, 4 maternity Hospitals
Furniture
: 76 Subcentres, 10 PHCs, 11 PHUs
Vehicles
: 15 Ambulance & 2 Jeeps
IEC activities
:CNA: Video-films, flip charts, hand books & hand outs
Baseline Survey :
NGO involvement:
Own Your Telephone
Contractual staff : Staff Nurses & Laboratory Technicians.
rchal8]
ai
LlkgORMANCE INDICATORS
P&QGRAMM£
0djectIVE
1
INDICATORS
(%)
> IMPROVED
management
w
I II- IMPROVED
quality
COVERAGE AND
effectivenes
111 ENAHANCED
POPULATION
STABILISATION
lidibdlj
1 DISTRICT
PLANS
.. CNA APPROACH
(%)
3. institutional
(%)
development
( placement of
STAFF)
20
50
(%)
3. I NFANT
MORTALITY RATE
PER 1000
Lbi
4. MATERNAL
MORTALITY RATE
PER 1OCO
Lbs
5. STAFF TRAINED
%
6. REACHED
WITH RTI.
hiv/aids message
%
7. UNMET NEED
%
PER 1000
POPUI ATION
58
52
4.5
2
20
18
22
2000
2001
2002
100
100
100
100
RECORDS (D&E CELL)
50
60
75
100
facility
SURVEY/RECORDS
25
50
75
100
FACILITY SURVEY
52
54
56
60
SERVICES STATISTICS
60
62
63
65
SURVEY/RECORDS
45
42
40
38
SRS
3.5
30
2.5
2.0
SERVICE STATISTICS
30
60
75
100
RECORDS
60
75
80
85
CLIENT SURVEY
14
12
10
8
house hold survey
25
0
43
1999
DATA SOURCE
0
(%)
2. COUPLE
—PROJECTION RATE
0. crude birth rate
1998
(%)
2- SC..PHC's, FRU's
EQUIPPED with'
1. SAFE DELIVERIES
1997
BASE
LINE
10
•
50
59
50
4
10
30
16
21.5
21
18
15
12
SRS
)
obstetric EMERGENCIES
Identifleati
m.^naaement and referral :
s^ucsement
az
INTRODUCTTriM, T
,,‘--- In Obstetrics there
is an extensive list
sudden and nr*
Potential
Obst +- ■
nexPected situations ,
,,
Which demand prompt act<
Obstetricians
Non
callously characterise obstetrics as -ho
boredom punctuated by
Hours ri-F
I
this has been stated,
moments o§.terror.
terror*
terror .
.s Obstetnet.ns we
moments of
6
however,
In modern Obstetrics,
fluid .«.=U'.VT"- eX"Pt
’i-tions
V12*r amniotic
ilsm, we can forearm ourselves by
complications by eacty identification of
anticipating these
lo each and
certain warning Signal
evary catastrophe.
s
Most of the
emergencies can be prevented in
reference of
PHC set up by early
Patients- with the high risk factors
antenatal
during the
Period to a major institution. .
)
However,
certain emergencies arise
even in a low risk
The PHC obstetricians should be
Pregnancy,
competent
enough
to
manage these emergencies to
identify and
prevent fatal sequelae.
CAN BE BROADLY CLASSIFIED
AS ZOLLQws:
OBSTETRIC;
~ ANTENATAL ;
a- Haemorrhage (Abortion,
Pregnancy)
b- Antepartum haemorrhage
J
c> Septic shock.
d- scar rupture (Classical
ectopic gestation
and molar
Scar)
j^Ptraparturn:
a. Rupture uterus
b. Shoulder dystocia
c- Third stage complicatlon
...
—-P PH
.
- Adherent
Placenta
- Inversio:n uterus
J
Antenatal & ‘‘-
£^apertun^ciampsia Obstetric
^Medical £
a« Venous thrombosi s
and pulmonary'~embolism
k* Cardiac
failure
c. Acute
J
resPiratory failure
Pyelonephritis
e. Diabetic ^etocidc-is
Sickle cell crisis
<2* Acute
Others:
J
a. Cord Prolapse
I
management and
+-on tial
k'l
. .2. .
b. Fetal distress
c. Unanticipated breechanticipated and referred early
The following emergencies could be
Abort!on, ectopic gestation and molar pregnancy.
a- Routine first trimester use
ovum missed abortion etc.,)
of ultrasound. (Mole b^ blighted
gestation in patients with abdominal
b. Early suspician of ectopic <
pain and irregular bleeding■ with or without amenorrhoea and
of conception during a MTP procedure^
failure to obtain products
If not recognised early:
—i
& resuscitate a patient with
One should be competent to manage
wqqIcJ be dealt with later*
acute massive haemorrhage which v.
Scar rupture;
.
All patients with
a previous caesarean
caesa-eau section should be
unital where facilities caesarean
by an Obstetrician in a hospita
section are available within thirty minutes.
J?
Intrapartum Complications
Identification
Rupture uterus
Refer:
a. Prior caesarean section
b- Malpresentations
x
n nmaress in labour (Use a partogram)
c • Patients with abnormal progress
d. Pregnancy with medical complications
e- Large babies
f. Elderly primis and grand multis.
shoulder dystocia
g- Previous history of
complications •
h. Previous third stage
Management
complications arise unanticipated as
However, occassionally
should be proficient to tackle them.
bolt from the blue- So we
\ )
. .3. .
ANTEPARTUM HAEMORRHAGE:
PLACENTAL ABRUPTION: •
Frequency l.in 75 to 90 deliveries
perinatal mortality 20 - 35%
gTIQLOGIC FACTORS :
1 Maternal hypertension
- Trauma
Sudden uterine decompression
Short umbilical cord
- Uterine anomaly
2
~ Uterine tumour
Pressure by the enlarged uterus
■i
- Dietary deficiency
on the inferior venacava
*" Cocaine use
- Preterm
prematurely ruptured membranes.
^S^CEJ^in 10 pregnancies
s
Sicrns & symptoms
Frequency^
U Vaginal bleeding
78
-Uterine tenderness or back pain
- Petal distress
66
60
- Abnormal uterine contractions
34
J-dropathic preterm labor
)
22
Dead fetus
15
Complications
Shock
>
Consumptive coagulopathy
Renal failure
Couvelaire uterus
Management
Blood,
>
crystalloids
Hasten delivery
Amniotomy,
Oxytocin,
Cryoprecipitate:
Treatment of coagulation defects
FFP,
Placenta Praevi a
T'otal, Partial
Marginal Types I to TV (Browne)
J
P i a q p osi s
1. Clinical picture
2. Placental localization
(TAS
J
Phenom enon of
< -
'f
by ultrasound.
- 95% accuracy) false negative _ 7%
Migration of low lying placenta.
J
•:x. 4..
I
f
Management:
Expectant form
Caesarean
. .4. .
of management Tocolysis
section at fetal maturity.
MgSo^
A Placenta
Previa, whether founH
clinical '”“P-ey of “tern.! ha,„orXgy1cr
ultrasound or with the
maternal
and fetal
significant maternal
Accurate ^^“"It.dudloious
transfusi ion es r
reo„,.
r
,
d
.
expectant management with
^required
maturation can lead
to the most favourable outcome of fetal l^ing
- XKXX
Anticipation or
- of hte clinical
complications
avoid some
Placenta accrete may
serious consequences.
Clinical j udgement
the performance
end skill in
°f Caesarean
sections, dilatation
uterine invasive
I
and other forms
techniques mey help to
Placenta praevia
keep subsequent incidence •, of
at a reasonably iOw
of
rate.
RUPTURE UTERUS •
Uterine
rupture is a sudden,
nnforeseable
rate of
„a perln.t_;..........”’“1'
that carries
a high
mortality.
uterine
ls
pr““llty' dignosis of
P-ompt surgical
experienced n , .
Pelvic Surg.on aQd Mm proauct i utervention with an
considered.
the
« ■««« rcptur.., replacement should be
evaluated for
patinet should be
po.slbl. repair or hystrecto.,/
consideration,
Re??r is a reasonable
V bv
th°S*
H.ve
deliver
undegone a repair, early
• prior caetlVe
"°“ld
with
prudent. In those patients
c fetal m onitoring to
Patients feta, a, r
.stress would appear
prudent. in these
common sign
or symptom of uterine
any other clinical manifestations
' thls coraPlications.
Incidence 0.02% to 0.08%
^££2^2" (Pluche et al)
Complete sep'^T^ythe waU
expulsion of the foetus.
Of the pregnant uterus
with or without
Clinical Associations
prior Caesarean
section
Oxytocin
Parity
4
^brupti^ placenta
Midforceps delivery
Preech version/extraction
Clinical_signs and
symptoms
- Petal distress
- Abdominal .pa.ln
• • 5 ..
. .5 . .
-Vaginal bleeding
i ;-X
Recession pf presenting part
- Uterine hypertonus
- Altered uterine contour
MANAGEMENT:
!• Resuscitation
2« Laparotomy - Rent repair
- Hysteeotoray
Shoulder Dystocia
Incidence 0.15-2%
This complication occurs unexpectedly and' leads
to panic stricken k
moments.- Hence, it is crucial for clinicians
to remain familia^^,
with.appropriate delivery maneuvers and to
organise them into
a systematic plan that willprovide optimal obstetric care.
Definition: Arrest of spontaneous
-delivery due to impaction of
the anterior shoulder against the symphysis
Diaonosis : head retraction sign or the turtle sign
-Prevention; -'••• '•
'
’•'• Anticipation- Antepartum
-...Is. this patients A DOPE?
.D-Diabetes
O - Obesity
P - Post' term/Prior large baby.
E-’s Excessive wt. gain
Advanced maternal age
Platypelloid or Contracted pelvis
INTRAPARTUM
Prolonged second stage of labour
.
Oxytocin use
Midpelvic delivery
J
Management; The shoulder Dystocia drill
The umbilical artery ph declines at the rate
3
of 0.04 PH per minute
Hence rapid and well cordinated action- is mandatory,
The price
of error ixxmHniscfcsixxxxxXbtH^Kg^e delay may be high«_
severe
neurologic and skeletal injuries to the infant, as well
as uterine
rupture or other injury to the mother.
all steps TO SOLVE A SHOULDEP.
*3
DYSTOCIA SHOULD NOT' TAKE MORE THAN
5 MINUTES
SiEP: I (
PREPARATION)
s.* Call for help - anaesthesia, operating room
b. Do not pull the bab^
head
Do not apply fundal p assure.
voO
- SOCHAhA
Koramanga^a
xsBangalore -
^o85
jj
V^~<ctieagZ
..26..
^£-2_(Diagnosis)
i
Enlarge the episiotomy
b- Explore manually - if bilateral -
restitute the baby* s head-
Caesarean delivery.
■-
Step 3 (
mc
Robert's maneuver) if unilateral
e• Remove! mother * s
legs from stirrups
b.Abduct 'her legs and sharply
flex them against her abdomen.
Causes ’ Cephalad rotation of pubic symphysis
freeing the
anterior shoulder.
PQSPARTUM HAEMORRHAGE:
i
PRIMARY 2 Blood loss of 500
ml or more occuring within 243^5.^
of delivery of the baby.
Incidence 5%
SECONDARY: Any sudden loss
of fresh blood ( regardless of volume)
from the! genital tract
occurring after the first 24 hours and
within 6> weeks of delivery of
the baby.
In <developing
countries PPH contributes for 28^ of maternal -d&adeaths. :In U.K. 4.33.
CAUSES66p666ary PPH)
1 .Uterine atony 9-&X
2. Genital tract tr'auma 7
3. Coagulation disorders
4. Large placenta
5. Abnormal placental site
6. Increased vascularity of the
uterus.
prevention
Prophylactic
: oxytocins at the onset of the third stage of labour
- Reduction of :PPH by 30-40%
b. Active
management of the third stage of labour
c. Avoidance of genital tract trauma
CIRCUMSTANCES WHICH INCREASE THE
danger of primary PPH.
a. Anaemia
b. Inadequate
access to clinical and laboratory support.
TREATMENT:
a. PPH before placental delivery
PP^ after placental delivery
c.. Massive PPH
BEFORE placental delivery
a. Uterine massage
b. administer TV Oxytocins c. Venous access t I V infusion (Plasma hiaod
expandes, Haemaccel,
d. MRP
MRP or cord tractionMxpapidx
blood)
. -7. .
■
after
-.7. .
PL-^CENTAL DELIVERY
* 1. Uterine
massage
2. IV OXytocic drugs.
3. Venous access
4. Catheterise bladder
5 . Explore uterus under G.Aof placenta or membranes
if there is doubt about
completebess
6. exclude genital tract
trauma when uterus is firm
PASSIVE PPH:
Extra expereinced Obstetrician midwife,
involvetnent would be necessary.
anaesthetist and haematologisi
Haematolooist! PT,PTT,TT, Fibrinogen
, platelet
for identification of a coagulation defect.
count and FDP
Generous supplies of blood.
Anaesthetist:
Further i v line, CVP
Extra midwife^ full
responsibility to keep up accurate,charts
of pulse, BP, - fluid ,balance C V P, temperature, respiratory and
the results of investigations.
Administration of one or several doses of 250
mg carboprost
<^oStodin)
B i najuma-x'
compression of uterus , laparotomy - suture of rupture
uterus. Internal iliac artery ligatipti.
MANAGEMENT OF pph UNRESPONSIVE TO'PRELIMINARY MEASURES:
>
Preoperative management options:
a. Uterine packing
b. Intramyometrial PGP
—P~rative measures:
a. Ligation of vessels
2 alpha.
Hypogastic artery
Uterine artery
b • Hysterectomy
c. Arterial embolization.
Intensive care measures:
Hemodynamic / renal and Coagulation surveillance.
CAUSES OP POSTPARTUM COLLAPSE:
1. Haemorrhage
Amniotic fluid embolism
J
S
3. Pulmonary embolism
4. Acute cardiac
failure
5 . Pneumonitis
6. Pneumothorax
7. Cerebrovascular accident
8. Ecclamps ia
9. Hypoglycemia
10. Septicaemia
XXX
)
I
i
. .8. .
r
■
RETAINED PLACENTA:
;
MRP if
■
30 mins.
Earlier if patient is bleeding
J
■i
PLACENTA ACCRETA, INEREXA AND PERCRETA
RISK FACTORS:
Age
(Low 30s)
Parity (2-3)
Praevia /Prior caesarean section (35%)
History of curettage (18-60%)
Prior'MRP
Prior retained placenta
Infection
Accreta (80%)- Villi attached to myometrium
Increta (15%)-villi invades the myometrium
,Percreta (5%)
villi through the uterine serosa.
.Incidence 1 in 2000 to 3570
Diagnosis ; a. AIH
. ^Antepartum: b* Sudden onset of blood in utine.
c. Abdominal pain with hypotension
d> Sonography - partial or total absence of subplacenta.L
lucent zone.
Management : a. Hysterectomy
Conservative:Leaving placenta in situ, localized resection and
repair
Overselling a defect
Blunt dissection/curettage
Methotrexate therapy.
SHOULDER DYSTO^CIA:
c. Assistant to apply suprapulic pressure directed laterally and
inferiorly.
d. Apply constant moderate flraction on the fetal head for a count
□f 30. Avoid intermittent pulling.
Step 4: 1. if Me Robert’s manoerbre i^uuls. attempt to rotate the
shoulder by applying pressure on the posterior aspect of the
impacted anterior shoulder to move it from the anteroposterior to
the oblique diameter of the inlet suprapubic pressure in the
same direction should be applied simultaneously. If room
under the symphysis pubis insufficient, perform corkscrew manoeuver
b. Apply pressure on the posterior aspect of the posterior shoulder,
attempting to rotate it anteriorly under the symphysis (Woods)
suprapubic pressure in the opposite direction should be applied
simultaneously.
— teP - L^traction of the Posterior arm)
The slide your hand in the vagina behind the posterior shoulder and
. .9 ..
t
/
a|°ng the poster!
■ h
”9*’
— p the posterior arm of the
the arm fiexed at thg
the
the arm along the fetal head
extraction of the posterior
»
• I
I
!
%
I
■
i
■_ i
. i- ■.
• I
i
i
%
!
I
I
arm is
unsuccessfui proceed
Step : e _(Zavanelli
step s
restitution)
Turn the Baby»s head
to the original
(Usually
Position at the
occipito anterior)
time of delivery
b- Flex the
head should
c. Move the
section.
»OV. .„lly "rtntoXX“thPr'"°re ■
The fetal
to the operatl„
““1crating room and
Perform a caesarean
ACUTE puefperat.
INVERSION OF The
UTERUSx
Uterine inversion
i may lead to profuse
and even death. ;
haemorrhage,
In no obstetric
profound shock
heneficial.
emergency is
Prompt action more
Inciden ce
ranges from 1
There are 3 degrees of in 2000 to 1. in 20, 000
deliveries.
- inversion,
i- The inverted
inverted fundus
fundus reaches
2. The whole
cervical os.
body is inverted
uPto the cervical Os.
S. The uterus,
cervix and va9ina
Ftiology: 1.
are completely inverted.
Spontaneous
2. Mismanagement
of third stage of labour.
Spo n t a neo u s:
1. Fundal~~
Placental site
2. Uterine
atomy
3. Arcuate or
unocornate uterus.
In Patients
with uterine atomy, the
cough. sneeze, or any other
inversio
n^ may occur filloying a
act causing
an ncrease in intra-abdominal
Pressure.
Mismanag^nt_o_f ITI stao^;
i• Cord traction before placental separation
2. Use of
Trade’s method when uterus 1
3. MRP when
< th. aMo.Iral band
and the ’vaginal hand, is withdra
7 P^sed on the uterus
hdrawn
to
quickly.
PRESENTATION;
1- Complaint of
severe lower abdominal
pain
..10..
..10..
2. Feeling of prolapse followed by collapse and haemorrhage.
PREVENTION:
1. Never exert cord traction’with relaxed uterus
2'. countertraction should be applied when the uterus finally contracts
3. Crede’s manoeuvere should not be employed.
MANAGEMENT:
1. Immediate replacement of uterus & I V bottles of Oxytocin^
2. Senate operation theatre for MRP
iate detection
1. Resuscitate
2. Alleviate pain by vaginal packing
relieves tension on ligaments.
3. Transfer to pperating theatre.
HYDROSTATIC REPLACEMENT (O'SULLIVAN)
Exclude uterine rupture and infuse warm saline from a container held
about 1 m above the. patient via a rubber tube into the vagina.
■••••: peeotocql :
. ■- ■Detected immediately: a. Peelr-off place-n-ta 9 9
b. Reinversibn by indentation of the center of
the fundus
c. Keep the hand in the uterine uavity till it
contracts strongly.
i
d. -Antibiotics
e. I V line
Detected after 30 mins.
A. Mobilise full hospital resource
b. Two IV lines
\
c. Indentation of fundus
d. If it fails Johnson's manoeuvre
e. If it fail^)|nuntingdons abnormal operation
f. Removal of placenta if inversion
g. Keep hand inside till uterus firm
h. Antibigtics.
OBSTETRIC SEPTIC SHOCK:
Definition: Infection resulting in peripheral circulatory failure
- to
cell dysfunction or
with inadequate tissue perfusion leading
■
death.
A high index of suspiciou$-<|inneection based on septic
syndrome would serve as a criteria for identifying patients at
..11.
risk for septic shock.
••llo.
SEPTIC SYNDRqmr:
Clinical evidence of infection
Tachypnea
7 '
fever or hypothermia
Tachycardia
End-organ manifestation
Neurologic changes
)
Hypoxemia
Elevated Plasma lactate
Oliguria
Data from Bone et al
epidemiology
Sepsis occurs more frequently following
gramz negative than
gram positive bacteremia.
hortality in Obstetric septic shock
20.50% of cases.
70% of maternal deaths
due to infection are
considered to be
preventable.
Therefore, it is important to
recognise the clinical
settings in which
—> septic shock is most likely to occur
so that
early recognition
and treatment can be effected.
Pregnancy represents
is a recognized risk
a state of altered immune competence,
and
factor for the development of
septic shock.
(
THAT RESULT IN SEPTIC SH_Orv.
Post caesarean section endometrium 15-85%
Endometritis follg.
vaginal delivery, 1_4% urinary infectio
ns 1-6%, Septic abortion
-1-2%, Intramniotic infections 1%
TYPE op
Necrotizing fascitis less thanl%
Toxic shock syndrome less than 1%
f
£21E*-^DISP0SING pactop St
Prolonged rupture of the
amndnii
Retained products of
conception.
genitourinary tract.
MICROBIOLOGY:
membranes (more than 48 hrs)
Any instrumentation
of the ’
gram negative FACU
--- LTATIVE ANAEROBES
Escherichia coli 5 0%
Klebseilla
serratia
enterobacter species
I
I
I
ENTROBACTERIAC £A E
30%
Gram positive aerobes
Staphylococci
streptococci
gram positive anaerobes
- Bacteroides
- Fusobacterium
- Peptostreptococci
. .12. .
..12..
onset of flu like symptoms on the
Clostridum sordelli - sudden
followed by progressive refractory
second to sixth day postpartum
These cases were unique in their uniform
hypotension and deathleukemoid reaction and marked vascular
absence of fever, striking
’leakiness*
Common clinical manifestations^
Cardiovascular : Hypotension, Cardiac dysfunction
Pulmonary : ARDS
RENAL : Oliguria
ATN
Interstinal nephritis
Haematoloaic
■J
I- DIG
- Leucocytosis
Neurologic : Mental - status charges
■ Fever
tests
MANAGEMENT: Initial laboratory
CBC
Electrolytes
Glucose
ABG
BUN creatining
Urinalysis
pjT fibronogen
lactate
Cultures
Blood
urine
Endometrium
Amniotic fluid
Wound^episiotomy site
Spu^W- drains
Chest X-ray, Abdominal X-ray
and Inotropic drues Naloxon^>
Drug: vasoactive
in respiratory failure
Mechanical ventilation
Antibiotic therapy
Surgical treatment
Debridement
Prompt delivery
..13
. .13. .
eclampsia
Eclampsia is characterized by generalised tonic,
in women with preeclampsia or hypertension
clonic seizures
aggravated by pregnancy.
indicators of severity OP PREGNANCY INDUCED HYPERTENSION :
Diastolic blood pressure 110 mm of Hg
proteinuria
Ior
more
Headache
Visual disturbances
upper abdominal pain
oliguria
i
convulsions
Elevated serum creatinine
* .
i
Thrombocytopenia
Liver enzyme elevation
Fetal growth retardation
Pulmonary edema
Treatment: Control of convulsions' with Parkland Hospital
MgSo^ Regime.
4
As loading dose IV (diluted)
1G per hour - continue 24 hrs after delivery/stoppage of
postpartum eclampsia
Monitor*: a. Pat^lae/refiex
b. Urinary output hourly
1
c. Repiratory rate
Control of hypertension:
Hydralazine IV/Nifedepin
Fluid. therapy:
L*.
)
Lactated Ringer's 100 ml/hr. If blood loss is more than average
earlier transfusion because in PE normal pregnancy induced hypervolemia is attenuated.
DELIVERYX Consider delivery when the convulsion are controlled
and the woman is stabilised.
Early detection and hospitalisation in woman with mild preeclampsia
may prevent eclampsia.
XXFUg AMNIOTIC AND THR0MB0EM30LISM:
The embolic complications of pregnancy are infrequently seen
but command much attention due to the high associated mortality.
80% of patients strucker—with amniotic fluid embolus wiifck die,
often before intensive monitoring can be instituted.
. .14. .
)
G'
. .14. .
DVT 3/1000 pregnant patients
Pulemboli - 15-24% of untreated DVT (12-15% mortality)
1. increased concentration of factors X,VIII,V,VII,
Causes :
IX, XII and fibrinogen
2. production of fibrinoly^i^
by the placenta
3. Venous stasis (Major contributor)
Signs and symptoms of DVT:
Nonspecific, pain,
Lowerberg test,
tendernesssr positive Homan sigjr^positive,
charge in limb color and a palpable cord.
DIAGNOSIS OF DVT DURING PREGNANCY
DOicrx:
EXX
■K<<
SUSPECTED DVT (HISTORY & PHYSICAL)
DOPPLER ULTRASOUND
EQUIVOCAL *--- NORMAL
^VENOGRAPHY -
ABNORMAL
4
REPEAT DOPPLER
AT INTERVALS
TREAT
DIAGNOSIS OF PULMONARY EMBOLUS
CLINICAL ^USPICION
VENTILATION
>ERFUSION L'
IG SCAN
ABNORMAL
NORMAL
PULMONARY ARTERIOGRAPHY
(PE EXCLUDED)
ABNORMAL
TREATMENT OF DEEP VEIN THROMBOSIS
Heparin
Complications of Heparin
-Bleeding
-Thrombocytopenia
-Os teoporosis
HEPARIN PROPHYLAXIS IN SUBSEQUENT PREGNANCY
AMI (DOT I c FLUID EMBOLISM:
Hypotension
H ypoxia
Coagulopathy
Mortality - 80%(left
ventiicular failure)
Dis serminated ■< -j tr a vascular coagulation — 40%
TREAT
'4
)
/
. .15. .
AFE reported in:
First and second trimester abortion (saline. urea)
Abdominal trauma
Amniocentesis
Vigorous labour and hypertonic uterine contractions
Placental abruptio present in 40%
Treatment:
Mainly supportive
)
a. Oxygenation
b. Maintenance of cardiac output and blood pressure
c . Combat the severe coagulopathy.
MASSIVE BLOOD LOSS IN OBSTETRICS;
In obstetric practice the threat of massive blood loss should be
considered once the patient has lost 1000- 1500 ml.
The fluids used during initial resuscitation depend on clinical
circumstance s.
Two group of patients can be distinguished.
a. Patients where resuscitation has been delayed - prolonged
hypovolemia
30 mins.
- Fluid loss from both circulation & intertitial space
1
- Lactated Ringers solutions or Iso.tomic saline (1-2 litres)
- Blood (if not available 1 litre colloid - haemacced)
ft• Sudden severe haemorrhage
1- Fluid loss from circulation
- First fluid blood or colloid.
■After 1-1.5 litres has been infused
the situation
a. c v\P
b. Arterial pressure
c. Heart rate (from ECG)
H. Hemoglobin & Haematocrit
e. Urine out-put
f- Core-peripheral temperative difference
g. Serum potassium, acid base state, clotting studies.
Practical aspects:
Venous access - 2 lines (14-16 gauge cases)
Blood warmer
Infusers, Microfibration, CVP & arterial line
Metabolic effects.
. .16. .
...16..
conclusion;
connected with massive
Thus most of the Obstetric emergencies are
knowledge and prompt
haemorrhage, be it during pregnancy or labour
action can save almost all the lives.
like shoulder Dystocia
Occasionally encountered emergencies
Sehearse and practise the steps
is an Obstetricians nightmare,
protocol in the labour rooms,
again and again. Display the
and refer for early Caesarean
Identify the patients at risk
section.
Emergencies like eclampsia and medical complications should be
thoroughly mastered by every PHC medical officer.
■
j
0
\ /
■)
Synopsis (Extended RCH Pro®to ramme)
An.
Examination of a Gynaecological patient
•
J<c.
J)tp
Leucorrhoea - Vaginal Discharge
• Vaginal swabs for culture
)
> For Trichomonas Vaginalis - Kupferberg’s or Whittington media.
> Candidada albicans - Nickerson’s or Subouraud’s media.
•
<
•
Slides - Test for Trichomonas Vagmalis / Candiada albic.
ans
Vaginal / Cervical Smear for Exfoliative Cytology
Indications :
> Screening Procedure (Down staging of Cancer Cervix)
>
> Cytohormonal study and
> Others
I
V /
6 s
PELVICE INFECTIONS
Causative Organisms - Normal flora of the vagina and cervix.
Exogenous sources - sexually transmitted or following Septic Abortions /
Delivery.
I
Pyogenic - 50%
Aerobes
> Gram positive are Staphylococus
> Gram negative are E. Coli, Pseudomonas, Klebsiella,
N. Gonoorhoeae
II
STD (Sexually Transmitted Disease)
•
•
•
•
•
•
•
•
•
N. Gonorrhoeae
Trachomatis
Treponema pallidum
Herpes simplex virus type II
Human papilloma virus
Gardnerella vaginalis
Haemophilus ducreyi
Donovan bodies
HIV lorn etc.
ill
Parasitic - Trichomonas Vaginalis
IVV
Fungal - Candida albicans
V
Viral
1
•
•
•
VI
Herpes Simplex virus type II
Human Papilloma virus
Condulomata Accuminata
Tubercular
• Mycobacterium tuberculosis
I
G?
Clinical features of Acute Salpingitis, Acute appendicitis and Disturbed Ectopic
Symptoms & Signs
Acute Salpingitis
Acute Appendicitis
Disturbed Ectopic
»
Acute lower
abdominal on both
sides
Starts near
umbilicus but
settles to right iiliac
fossa__________
Unrelated
Acute lower
abdomen on one
side
Inconsistantly
present
Usual
Absent
Face - flushed
No significant
change________
Rapid but
proportionate with
temperature______
More raised
Lower abdomen on
both sides
Toxic
Furred
Pale
Pale
Rapid, out of
proportion to
temperature______
Slightly raised
On McBumey’s
point. May have
music guard
Tenderness on right
fornix and hig up
Persistent rise
even with normal
temperature____
Not raised______
Lower abdomen
more on one side
Pam
1
•
Amenorrhoea
and bleeding P V
• G I symptoms
such as nausea,
vomiting
• General look
• Tongue
• Pulse
•
•
Temperature
Tenderness
•
Per vaginam
Unrelated
>
)
»
Tenderness on both
fomices. A mass
may be felt
Usually present
Mass may be felt
through one fornix
extending to pouch
of Douglas.
6^
MODE OF INFECTION
• Acute Pelvic Infection
> Pelvic inflammatory disease (PID)
(PID)
> Following delivery and abortion
>. Following gynaecological procedures
> Following IUCD
•
PID (Pelvic Inflammatory Disease)
> Definition
> Risk factors
> Protective
> Microbiology
> Signs
> Investigations
•
Clinical Features
>
>
>
>
Rise of temperature > 38° C
Lower abdominal tenderness
Tenderness on movement of the cervix
Adnexal mass
> The supportive diagnostic aids are :
> Blood - Leucocytosis > 10,000 per cu mm
> Laparoscopic evidence of tubal affection
> fi'T With pun'lcnt f,uid ha™’8
> 30,000/ml.
Differential Diagnosis
•
Complications
> Immediate
> Late
> Treatment
“U count
/
•)
OUTPATIENT ANTIBIOTIC THERAPY
•
Non-penicillin allergic patient (any one)
> After 1 gm probenecid orally
> Amoxycillin 3 gm orally
Ampicillin 3.5 gm orally
> Aqueous procaine penicillin 4.8
1
mega uniti.m.
Penicillin allergic patient (any one)
> Streptomycin 2 gm i.m.
> Tetracycline 1 gm loading diose
All patients should receive orally 7-14 days course of (any one)
> Tetracycline 0.5 gm 4 times a day
Doxycycline 0.1 gm twice daily
> Erythromycin 0.5 gm 4 times a day
indications of INPATIENT antibiotic therapy
•
Adnexal Mass
•
Temperature > 38° C
•
Uncertain diagnosis
>
Unresponsive to outpatient therapy for 48 hours
•
Intolerance to oral antibiotics
•
Co-existing pregnancy
.>
*
'I
ACUTE PELVIC INFECTION FOLLOWING DELIVERY OR ABORTION
• Clinical features
• Complicated clinical manifestations
• Treatment
• Prevention of sepsis
• Curative
> Hospitalisation
> Triple swabs for sensitive and Gram stain
> Bimanual, Vaginal, Rectal expanding
• Definitive treatment
> Supportive therapy
> Active surgery
> Late sequelae
ACUTE PELVIC INFECTIONS
• Following Gynaecological procedures
• Clinical features
• Treatment
> Prophylactic
> Definitive Treatment
IUCD AND PELVIC INFECTION
1
With all types more chances in nulliparae
7o
CHRONIC PELVIC INFECTION
I
•
Pyogenic
•
Clinical features
•
Symptoms
•
Important factors for infertility
ON EXAMINATION
)
t
•
For Abdomen
•
For Vagination
•
Rectal examination
INVESTIGATIONS
Blood - WBC
> TC
> DC
Urine examination
> Routine analysis
> Culture sensitivity
)
•
Laporoscopy
•
Diagnostic Laporoscopy
•
Differential Diagnosis
•
Management
General
Specific
> Surgery
)
:■
I
?
!
I
7/
VAGINITIS
•
Candida (Moniliasis)
•
Chlamydial Vaginitis
•
Atrophic
> Vaginitis
> Non specific vaginitis
•
Toxic shock Syndrome
CEREVICITIS
Acute
•
Chronic
•
Endometritis
> Acut£
> Chronic
ORGANTSATIO NA h SRT TTP
OF
HEALTH AND FAMILY WELFARE DEPARTMENT
The heal tn being the State
subject under the constitution,.
the State Governments are
responsible for the promotion and
protection of Health of their citizens.
The health of the people
in any area is depended on:
I
1. Jnvironniental condictions
2. Diseases prevelent in the area
3. Socio-economic status of people
4. Nutrition
f • Availability, accessibility,
—
....
affordability
and acceptability
of
Health
1
uez.lth Care Services.
1
Tie State Government have, the
responsiblity of providing
the Health Care Services through the Health Department
and other
social sectors.
1. Health promotion services
2. Prevention end control of diseases
3 . Providing Diagnostic and Curative
Services (0P1 & IPD)
4 . Rehabilitative Health Care
Services
To provide above Health care services,
the^ Department of
HeaJth and Family Welfare has to have
an organisation from State
>
Head Quarter to Community ^evel and to have needed
man power, both
Medical and Para-Medical ard infrastructure
facilities by establushing Sub-Centres, PHC CHC and
up grading the District
Hospitals for providing Health Care Services.
as ;
I
The Health Care Services provided in the State
is classified
1.Primary Health Care Services
2.Se co nd ary He a 111 care
-At Sub-Centres,
3oTertra.i.m Health 3are Services
-Major Hospj.taJ.s and Super
PHCs
-CHC, Ter. Level Hospital,
Sub-Divisional Hospitals
and District Hospitals
S r c i a 1 i t V H o s p 11 a 1. r.
Hz:-J ayadeva Institute of
Cardiology, Kidwai Memor.ial Institute of Gncolody
NTMiimig etc. ,
2
/
/
7^
2 :-
In addition to above the various
National health and
Family Weifare
Programmes are to be implemented as per
guidelines of Government of India.
Accordingly the Organisation of Health and
Family Welfare
Department is set up in the State
to achieve the above.
The Organisational
set up at different level is enclosed.
i '
Y
ORGANISATIONAL SET Up
OF
health AND family WELFARE
department
sbcretarjat LEVEL;
MINISTER of health and
family welfare
government of KARNATAKA
t---
DEPUTY SECRETARY
\7
i.f.a.
UNDER
UNDER
secretary
SECRETARY
C & R
SERVICES
UNDER
UNDER
SECRETARY
HEALTH
UNDER
SECRETARY
R & I
SECRETARY
I.S.M.
X/
UNDER
SECRETARY
LEGAL CELL
r
II
11
STATE LEVEL:
V7
SECRETARY
HEALTH ANO FAMILY WELFARE DEPARTMENT
- -J
I
I
I
I
I
DIRECTORS
SIHFW (r
4,
PROJECT ADMINISTRATOR
-------- DIRECTOR
CUM E/O.ADDL.SECRETARY--- ■> HEALTH & FAMILY
K.H.S.D.P.
WELFARE SERVICES
NJ/
PROJECT DIRECTOR
4 CUM E/O.ADDL.
SECRETARY, IPP-IX(K)
4T
DIRECTOR
I.S.M.
PROJECT DIRECTOR
KfW
PROJECT
JT
DRUGS
‘controller
organisational setup of
health and
DIRECTORATE LEVEL:
Pamily welfare department
*****
director of health and
addl.ur~
IRECTOR
(aids)
DEPUTY
DIRECTOR
(aids)
DEPUrrf
director
(b.b.)
family
WELFARE
SERVICES
--------addl.DIRECTOR
((FW & MCH)
JOINT
GRAPHER DIRECTOR
director
(FW&MCH)
(IEC)
ADDL.DIRECTOR
(CMD)
T
A.O.
JOINT
DIRECTORS(9)
(HSJ^
addl.DIRECTOR
I• H & p
2. M & p
JOINT DIRECTOR
(HET)
3. T.B.
4. leprosy
5- P.H.I.
6. VACCINE
INSTITUTE
belgaum
1.
OPTHALMOLOGY
8. MEDICAL
9- <5.M.S.
<1
1^
C.'k.o.
c.f.<
CUM
F.A,
DIVISIONAL LEVEL
director of health and FAMILY WELFARE SERVICES
1
DIVISIONAL JOINT DIRECTOR
D.tk (HQ. )
DISTRICT LEVEL:
G.A.
DY.DIRECTOR '
NMEP ZONE
~T--
DIST.HEALTH &
FAMILY WELFARE
OFFICER
J,
H.O.
SSA UNIT
(LEP.)
r^.o.
MOBILE
OPTHALMIC CUM
DENTAL UNIT
(SCHOOL HEALTH)
SURGEON
(LRU)
DI-ST. SU JgEON
DIST.HOSPITAL
I
district level
ZILLA PANCHAYAT
C.E.O.
J
DISTRICT HEALTH AND FAMILY
g.a.
r
d.m.o.
1
1
DI ST.
m.c.h.
©FFICER/D.I.O.
M.O.
(F-W.*)
WELFARE OFFICER
D.L.0.
1
D.T.O.
M.O.
C.C.T.
M.O .
DIST.HEALTH
lab/
DlST.SURVEr
M.O.
taluk level
'm.o .
phu/phc
llance unit
BLOCK LEVEL
MEDICAL OFFICER
PRIMARY HEALTH CENTRE
I
I
1
B.H.E.
SR.H.A.
(M)
SR.H.A
(F)
f
JR.H.A.(M)
JR.H.A.(F)
LAB.
TECH.
F.D.C.
l/
> ••
K AR N A T A K A
■
Demographic 1 Scene
',H. Glia he e ‘
i 1 *• Karnataka, is, one of_ the Bth^Jor ..State, in, India.
2. Geographical ar^
rrj ,1,92 lakhs, Sq.Km.
3. P^Jeeted .Population^ 3(/o0
4. No.of Revenue Division^}
i
i r.n
5^ No.of Districts
- 20 + 7 New Districts
6. ' Taluks
7. Durban Populatibni('^^^£<L^:40 Crores'. v':'
j . d
8. Rural' Population 088 - ditnL .3/10 ^Crores r
9. Male
9
s
}
h:
J
d
HonH
10. -- —- —...
11. Sex Ratio
Health Instltutions in
960 Females/1000 Males.
Karnataka
1. Total No.of Health Institutions
2336
2. Total Bed Strength
3. Teaching Hospitals
4. No.of District Hospitals
5. No.of Hospitals 50 - 100 Beds
6. No.of Community Health Centres
38505
>7
7. No.of Primary Health Centres
(GOIP 262 + MNP 1332)
8. No.of Primary Health Units
9. No.of Sub-centres
10. No.of Maternity Annexes
11. Population Bed Ratio
I
20 + 7
52
242
1601
- 589
- 8143
- 279
.
- 1.428/1000 Population.
Demographic Para-meter;
1. Annual growth rate
2. Decimal growth rate
3. Birth Rate
4. Crude Death rate
5. I.M.R.
6. M.M.R.
J
J
7. Reproductive age group (F)
8. Mean age of marriage of girls.
9. Life Expectancy - Male
-doFemale
- 1.9%
- 21.11%
- 23
7.3
53
-.4.5
- 15-29Yr.
- 19.4 yr.
- 65-55 Yr.
- 66-55 Yr.
P,T.O.
y
k /
21
2
a t a :••
a
:—
A
Beds Distributed->in Health Institutions:District’Hospital’5H
J'2 50‘t6‘;750 '
•m Taiuka Hospitals' — 3©— 100,r& above
-
million
Community'Health Centreslf--’30u^-‘50 beds - 1 ; •
Primary Health'Centres'10--1^';fJ
vUoUle.i.G v -i- ‘ ’ Oh ‘..U
: .
population .Bed Ratio
- 1.428/1000 Population
_ Population
Mysore Type of Dispensary/PHU.
Population
Cost
primary^ Health .Unit
■.< .S
589
6.00 lakhs
15000; r
no Us J u
- '
Sanction
of Primary
Health Units stopped .t'since
1984.
• • j J !
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;
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GALOiCS
SI.
?<:o .
-srrip-i on of por/era
1
L.ii’3L 8TH UiJCH 1996
rector of tIP7/yj-j/ ~ ~ ~rT7- ~
4ddl.Lire,tor(flCHuH?')
working
luk level
-•idol ,i>i rec tor P»ILs)/
33 ^ogranme Off-~ Officer/ dist. Medical
Sn
v
Officer9/
AgcI.director (ProiAo + V 1-<?9rs in *;e ,
Surge on/Dy.
.Medical
z
•h • •
•
fMC/Senior
!?
ffi<
-sr/Speciageo!.,!,,,/
list/huty L’edieoi
principals of
principal of
'-’iflccr
Leaical/Dental
HP*7 Training
Spec iali st/
Lolleges/Supdt.
Centres/
epj'ty Medical
of teaching
College of
Officer at
Hospitals/'
Hursing/^dmn. Taluk Level/
Ohief udon,
Off i cars jDl)
^LC/^iO/ppc/
°ffi^er/birecMedical
Offi
•
tor Linto
Health Officer cer List.
Hogicnai ln5]tt
(SSA UHI?)/
Health Lab
of Ophthalc:oMedical Officer oratory/
locv. Jn(rr.;S)/
Lapreay
Medical OffiJ -"X1. Tccine
Hosni tn.]/
cer(y.^:i.JCH')
Jr st.)
Surgzon ’ilPU/
Ledical
Vx-L
Officer (L?C)
J-.,T3.S* lore.
^hi.’noga .
Medical Cffi c^>,
(HTT)/Di3t.
Training
Officer:
3
4
5
6
I
Pull powers
----Sites'
gc^^2 01 9tl^s
Full powers
by
• a. [0
th:- Staff
threa years
^axiaur, p 1?- cf whoE of the
a m below
for bcpvicf; t
riu r
• ’ una,3r local bodies
t^Cocunr
g,i ?services
aer\ices rules KCSH3
forcigr
Coc^^3al under takings (l)
in place of
current
®axiDUCi pay of
2 the
—2 r
related poet
kl.a. class-I Junior cale Grade in
three year’s
(non-Ga2S tted)
!
o
^1/
>
1
2
5 c . jjeii'inurggt and v.e Lfnre charges
provided they <• re not caused by
the •* - <1' 1 i gc nee cf a ny Go var na -en t
serve, rt.
cl . Purchase of >L-rny photo films
3 .
’.•.ainte ranc' of frogs, rabbits,dogs,
rat.:.. v/hit.j rats and other z;m
’•ram als □requirrd for experiments
in Pedicel joIjages ana'other
Inst i tu tin.is.
-3-
3
4
5
Full power
^s.2,500/each time
Bs .2, 000/each time
Hs .500/e.aeh time
©11 p o v;e r s
Full power
Full po\7.= r
Full pov.er
nil
Hs.10,00'?/euch time
i?3.5,000/e'lch time
f . 3ug.?1: ?l
to i.he inmates
cl
*i ncso:• t'..l ?. ru Leprosy
lie-"3 per yeir.. •
2s.150/- per
each pair .of shoes
per inn..:xe (i iert :1
Hesoltnl)
-5s.200/- to
i rm a t a of L?»' r o sy
Hosni ml par case
nor year
6
2s.15C/- n~r
inrh nair of
shoes inr.ndie
o.f i'ental
Hr so i tai and
2s.20c/- p?r
inmate of
Leprosy
Hospi tai per
case per yr.
2 s . 15 •/- c c- r
paid of
shoes to
ink-.to of
Mental Hooci ta 1
a nd .5.3.200/per pair of
shoes, to
i
inmates of
Leprosy Hosp
ital par case
oer year.
^s. 2,500/-
:t3 .1,000/-> 23ch
ticia to control
plagu=.
!
g?w h
g. Me asun-s i'or <ce ntral of Plague and
other under tlx
*.i following Heads. ’
i) Coni, cruet ion and repairs of
segregvTion camps -nd Hospitals
)
full p o vie r
>3.5,000/-
ii. Purchase i nd carriage of Medicines
iii. iiietary cl urges
3
1
-5-
2
3
o- Glassware, (Chemicals & /lejdr
La b c.-rn t cry ne co s sari
3» other
Cohe
and other 7
--■ge-s
Full powers
Lo snneticn
expenditure
renl/jeemen t c i parts ana on fixing
servicing
or repairs of
Full powers
I'ltr ^-saind, Tndos
copy
rd Ou her
•chines.
b. 3torilia-dfn/Iii( ■
ordsc opes/
—tors and
— •. j other
oquipments.
c.
Full powers
Full powers
p
G .
•rrj-nnu r’.nuirs <»f" Sulldingo 1„
rssrset ofrLetri
r.-nu
nn wa^cr
8 . Tc ?c-accept Gift.? a rn
donations for
public c,
o r instr um e n t s for
unaar th
ha5 c -vitrei
1
9. To sanctifn
fund Of tijJ 5X nc nd it ture
Hc.apita 1
Pull powers
out of ptor
10. To £3t font not
‘■re.ss, pri ntc '1 -y
ordar th”?rit
d
olaposnl
Pull pc vers
Pull pov/ers
4.
5
33.25,000/e^ch time
limitad to
-^s. 1/-lnkh
per annum
ils. 10/-lakh 3
psr annum
^•V-l-kha
P-r annum
3s -5/-lakhs
per annum
fts..?/- l.-'kh s
pc-!• annum
Pull powers
Pull powers
*s.5O,000/each time
limited to
Fs.l/~lakh
per annum
Ps .5/-lakhs
per annum
3s.10,000/per a ry?UQ
33.1/- Lakh
per annum
^s «1 0, 000/per
annum
3s.1/- i?kh
per a nr urn
lakh
P-r a nnum
Pull o o v/e r s
3s.5oo/-e3ch
t ime
*
Pull powers
find to
Pull powers
nil
3.s. 10, 000/ench tine
11mi tad to
Hs.l/- lakh
per annum.
Full powers to
the (extent of the
powers
-- to
-3 fu
purchase
these items.
6
3a.25,0C0/P3r annum
•10,000/por annum
Pull cowers
i?s.5O/- each
t ime
Q
• W, ooo/_
P9r annum
cr6
-71
2
3
19. Purchase
prrcuctirn of film
. 16 ■1 Cf-rIf-35____ rco.
cna Video,- . _films
Pull pr wars
4
5
6
rts. 3/- lakh a
per annum for
purchase mly.
20. rfehihitien i. s . Llys: re Lasnrn Ma jr-r
jxhibitian i'rcgratxie
21 .
Rs.5/- lakhs
each time
ringing of publication rec^rts/
Manual -.uiJelinss.
^s.1/- lakh per
annum
Pull powers.
3<-/-X
(JOYO7 SUitT^K.;)
Internal Pir-incial auviser,
Health an<- Family '..’el fare Beptt.
/copy/
I
i
i
for Director of Health & FW Services.
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57
I
l
I
I
4
R ECR UITMENT
THE KCS (GENERAL
A) APPLICATION:
RECRUITMENT rules, 1977)
L$ri- P. Ramanathnn"
APPLICABLE (RULE
1 (3) (A)
Se,",0" SX“S a"d P0S“ “
thcre are „0
contain an ovXndinTX7"' ''h're d'“e ru,es
an
clause) or where in the sPeH T" (non'obstatante
specific provision
P
es there are no
NOT applicable (RULE 1 (3) (B))
India Services
-) To Industrial undertakings
3) To Casual employment. “
4) To Work-charged establishment.
B) METHODS of
RECRUITMENT:
^his is the core cP
of the rules. The rules give the different
methods ofrecruitmi
—tent and the incidental
provisions.
Basic methods of
Exceptional methods
recruitment
of recruitment
(1) Direct recruitment (R-3)
1) Re-employment
<R'I5(l)(a))
(2) Promotion (R-3)
2) Contract (R-15(l)(b)
(Note: Of the two methods the
3) Transfer (R-J 6)
method to be followed and the
4) Deputation (R-16)
Qualifications required shall be
specified by the C&R Rules).
Consultant. DP.<R,
I
\ /
(I) DIRECT RECRUITMENT
>
Defmition: Appointment otherwise than by promotion,
transfer, re-employment or contract is direct recruitment
(Rule 2 (I) (g)).
There are two methods of direct recruitment:(i) by competitive examination;
(ii) by selection (Rule 3 (I)).
PROCEDURE OF APPOINTMENT:
If by competitive examination in the order of merit prepared
by the selecting authority on the basis of such an
examination (Rule 4 (l)(a)).
If by selection, after giving adequate publicity in the order
of merit determined by the selecting authorities (Rule 4
(l)(b)).
f
(2 ) PROMOTION:Definition:- Appointment of a Government Servant from a
post/grade/class of service to a higher post/grade/class of
the service (Rule 2(1 )(m)).
€
(Manager Sri V. Rangachari AIR 1962 SC 36).
Here also there are two methods:-
<
(i) Promotion by selection;
(ii) Promotion on the basis of seniority-cum-merit Rule 3(1)
PROCEDURE OF PROMOTION:If by selection
(i) On the basis of merit with due regard to seniority
(Rule 4 (2)(a))
(ii) merit is determined on the basis of sen/ice records ACRs, APRs, personal dossier and SR.
C
2
gay
(iii) Seniority brings within
the zone of consideration only
(provision to Rule 3(j)(a)).
Union of India-V/s.-Srivatsava- 1979 (2) SLR 1 16 SC)
Zone of consideration is 2n - 4 where ‘
n’ is the number of
vacancies.
(iv) Seniority is not the sole criterion but it
counts when two
or more persons are of equal merit.
(N.fCPanda - Vs-Union of India - 1977 (2) SLR 589 '
(Orissa)
(V)
thTn^
Pr°V,SiOn 13 llm,ted t0 the P°st of ^ds
of the Departments and Additional Heads of the
Departments in equivalent grade - Rule 3(2)(a)
If on the basis of seniority - cum - merit.
(ii) iXm Seni° i^'
SemontyRules0'
d /eV,srai cadres or classes of posts of the same
grade by the length of service - Rule 4 (?) of the
•Seniority Rules.
sXtanrdLsZZ^fdTamtmT6^
C&R mleS are
(^kmds0
°r C‘aSSeS °f P°StS Of different
inds, by the order in which the names are arranged by
the appomting authority - Rule 4 (iii) of Seniority rules)
( ) This method of promotion is applicable to a^l pos s
other than HOD and AHODs - Rule 3(2)(b).
(3) RE-EMPLOYMENT:-
otaS.a.e&veX^
of r“r=a Go—
'■
C°"' "d
(2) Terms and conditions are unilateral
one sided
determined by Government under roles
(?) Period of re-employment as
d
determmed by the Covert , mu
and as
Rule 1 5 (1 )(a)
TherS 1S n0
-
3
u
7©
(Note:- Extension of service in continuation of service end it
cannot be granted beyond 60 years) - Rule (15 (n) of KCS)
(4) CONTRACT:(1) Slightly different from re-employment.
(5) any eligible and suitable person can be appointed.
(b) duration of the appointment is normally not
beyond five years.
(OM No. DP AR 15 SDE 85. Dated 1 l,h June
1985)
(5) TRANSFER AND DEPUTATION:-
(i) Government may appoint to a post an Officer of
the Defence Service. An All India Service or a
Civil Service of the Union or the Civil Service of
any other State. This appointment can be either
by transfer or deputation. For such transfer or
deputation equivalence of grade is not necessary.
(ii) Government may also order transfer or
deputation, from one service to other service or
one depanment to other within State Civil
Services.
(iii) To effect transfer or deputation from one
service to other the following conditions should
be satisfied.
(a) Reasons to be recorded in writins.
(b) The post in which the official is workins
and the post to which he has to be
transferred or deputed should be in an
equivalent grade.
(c) The official should be capable of
discharging the duties of the post to
which he is transferred or deputed.
(iv) Government may appoint an official who is
permanently incapacitated for the post which he
is holding or to another post where his services
can be utilised. Such appointments.
(a) cannot be to a lower post unless the
official consent to it or
4
(
<
€
"7/
(b) to a higher post unless there is no
equivalent post.
Government may similarly appoint an official whose
service is temporary incapacitated.
Such an
appointment can be only for the duration of the
temporary incapacitation.
(6) Government may appoint by deputation of a person to
any Group-A post in the State Civil Serv.ces If such a
person is>
(a) In the service of any University in India;
(b) In an equivalent grade; and
(c) m possession of speacialised qualification;
Period of deputation - not exceeding five years.
C) MATTERS RELATING TO
DIRECT RECRUITMENT
D) DISQUALIFICATION:
It is a negative provision. The qualification is not to
possess the disqualifications listed by the rules.
'The disqualifications are:(1) Not being:-
(a) a citizen of India, or
(b) a subject of Nepal, or
(c) a subject of Bhutan, or
(d) a Tibetian refugee, or
(e) ^person of Indian origin migrated from
Pakistan, Burma, Sri
-J Lanka and East
African Countries of
( Kenya, Uganda,
Tanzania, Zambia,
Malawi, Zaire,
Ethiopia and Vietnam;
(2) a man having more than one wife living;
(3) a woman married to a man already having a
wife;
(Govt may exempt the operation of this
rule in
special cases).
(4) Persons attempting extraneous
support for
appointment,
5
u
rZ
(5) applicants in Govt employment not making the
application through proper channel (Exception
Local Candidates);
(6) for appointment as peon-not passing standard
examination and not expressing willingness to
serve as Home Guards;
(7) persons associated with unlawful organisation.
(8) Persons associated with activities such as
• subversion of the Constitution,
• Organised breach of law involving
violence;
• causing prejudice to the interests of
sovereignty, integrity or security of the
State;
• promoting disharmony among different
sections of the people;
(9) persons dismissed from Central or State Govt. Services;
(10) persons permanently debarred by the UPSC or any
State PSC.
(11) persons convicted of an offence involving moral
turpitude shall not be appointed unless all
the
circumstances are reviewed and their suitability tested.
(12) persons temporarily debarred by the UPSC or State
PSC’s shall not be appointed unless all the
circumstances are reviewed and their suitability tested.
- Rule 5.
2) AGE
(1) MINIMUM
18
MAXIMUM
38 - SCs/STs/Category II
36 - OBCs
33 - GM
Age to be reckoned with reference to the last date fixed for the
receipt of applications or a date specified by the appointing
authority.
- Rule 6 (I)
(2) If the C&R rules do not provide for enhanced upper age limits
for SCs/STs and other Backward Classes, then these upper asze
limits will prevail - Rule 6(2)
(3) If the C&R rules provide for lesser upper age limits, then these
upper age limits will prevail - Rule 6 (2A)
(4) Relaxation and enhancement in upper a^e limits.
6
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r;
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(a) Relaxation
In the case of repatriates trom East Pakistan (Bangladesh),
Burma, Ceylon (Sri Lanka), East .African Countries (Kenya,
oan a, Tanzania, Zambia, Malabi, Zaire, Ethiopia and Vietnam,
the upper age limit shall be relaxed;
(i) by 3 years for
tor recruitment through competitive
examination;
(ii) upto 45 years for all other recruitments;
and
this shall be further relaxed by 5 years for SCs and Sts
among them.
(b) Enhancement:
(1) by 10 years in the cases of a candidate’
*)
who is or was holding a post under the
Government or a local authority
authority or a
Corporation (if the number of years of service is
less than 10 years then by the number of years of
service);
ii) who is physically handicapped
iii) who is a widow;
iv) who was a bonded labourer;
(2 ) by 5 years in the case of a candidate;
i)
for appointment to a Group-B post on the
personnel establishment of a Minister, Minister
of State or a Deputy Minister coterminus with
the tenure of the Minister;
ii) who is or was holding a post under the census
organisation. (If the number of years of service
is less than 5 years then by the number of years
of service);
(3) by the number of years of service in the case of a
candididate;
i) who is an ex-serviceman + 3 years’
ii) who is a rleased NCC foil time Cadet Instructor
iii) who is or was a Village Group Inspector under
Rural Industrialisation scheme;
iv) who IS or was a member of the Staff of former
Maharaja of Mysore.
(Rule 6 (3)(b))
7
7//
Application through proper channel:
Persons already in Government service should make the application through the
appointing authority.
This condition is not applicable to Local Candidates
(Rule 1 1)
FEE
i) As prescribed by the PSC or other recruiting agency in consultation with
Government in respect of application and examination;
ii) as prescribed by Government in respect of medical examination.
Exemption of fee:
i) Total exemption in respect of SCs/STs/Category-I
ii) This exemption in respect of displaced Goldsmiths;
iii) total exemption in respect of migrants from Bangladesh, Burma and
Srilanka for recmitment through PSC only.
(Rule - 13)
Suitability and Character:
i) to be tested by detailed verification int he case of Group A &B;
ii) to be tested on the’basis of certificates in the case of Group C&D
€
(Rule-19)
Physical Fitness:
i) detailed examination by a medical Board in respect of Group A&B
ii) On the basis of a certificate after examination by a Medical Officer not below
the rank of an Assistant Surgeon.
(Rule-12)
c
i) 15 days from the date of despatch of the appointment order by registered post;
ii) pointing authority may grant such further time as deemed necessary on
application made within time;
iii) the name of a candidate who does not assume charge of the post within the
prescribed time or extended time shall stand deleted from the select list.
(Rule - 18)
8
f
7^
Probation:
All appointments by Direct Recruitment shall be on probation for such period, not
being less than two years.
(Rule - 19)
Misconduct:
A candidate producing falsified documents or using unfair means in connection
with his recruitment is liable to,
i) criminal prosecution;
ii) disciplinary action;
ui) debar permanently or temporarily by the Commission from admission to an
examination or interview;
iv) debar from employment by Government.
Ex-servicemen and
Physically Handicapped.
Wherever there is an element of direct
Recruitment 10% of the vacancies available for such
direct recruitment on any occasion shall be
earmarked for ex-servicemen, 5% for physically
handicapped persons, and 30% for women.
This is a reservation under Article 16 (1) of the
‘Constitution of India. This is called horizontal
reservation whereas reservation under Article 16(4)
of the Constitution of India is called vertical
reservation. The horizontal reservation has to be
within the vertical reservation and the overall
reservation should not exceed 50%
For this purpose 10% of the vacancies for Exservicemen, 5% of the vacancies for physically
handicapped and j0% of the vacancies for women
shall be set apart in each of the categories of general,
merit, scheduled castes, scheduled tribes and in each
of the categories among other backward classes
identified under Article 16 (4)
(Rule -9 and 3B)
Officiation: - .All appointments by promotion shall
be on officiating basis.
The period of officiation shall be one year unless
otherwise prescribed in the C&R rules
9
u
This period of officiation imay be extended by
another year by appointing authority
No further
extension is permissible.
The period of ofticiation may be valued if the
official has already discharged for the period of one
year duties of the post to which he is promoted.
The period of officiation may be reduced by such
period not exceeding the period during which the
official has already discharged if any, the duties of
such post.
On the expiry of the period of officiation either it has
to be declared as satisfactorily completed or the
official reverted.
After declaration of period of officiation the official
may be confirmed at the earliest available
opportunity.
INSTRUCTION ON PROMOTION:-
No person retained in service after the date of
superannuation shall be promoted to a higher post
This restriction does not apply to officials who have
been retained in service upto the last day of the
month m which they have attained the atje of
superannuation, in accordance with rule 95 (a) of the
KCSRs.
COMMON PROVISIONS:
(Rule -7)
1) Reservation:- Reservation for Scheduled
Castes/Scheduled Tribes and other Backward
classes shall be made to such extent and in such
manner as may be specified by Govt, under Article
16 (4) of the Constitution.
(Rule - 8)
Government have been issuing orders under Article
16 (4) from time to time and at the moment orders
issued on 20-6-1995 and connected orders in respect
of direct recrutiment and orders issued on 27.4.1978
and the connected orders in respect of promotion
10
r
are in force. The policy of reservation is not
applicable to other methods of recruitments
2) Appointment by direct recruitment or bv
promotion:i) a vacancy identified for promotion mav
be filled up by direct recruitment if no
eligible person is available for promotion;
ii) a
vacancy
identified
for direct
recruitment may be filled up by
promotion when such vacancy is not
likely to last for more than one year;
PROBATIOlN/OFFICIATION
No person who has not completed the period of
probation or officiation, as the case may be
satisfactorily, shall be eligible for promotion.
-Second provision to rule 3 (1)
11
()
Seniority
I.
Application
The Seniority Rules, 1957 are applicable to all Government servants except to
(a) local candidates (Rule -1 A)
(b) allottees in determining their initial seniority. (Their seniority shall be determined
in accordance with section 115 of the State Re-organization Act, 1956 and the
orders issued thereof).
r
t
f
12
71
II. Principles of Seniority
What is Seniority ?
Persons appointed earlier either by direct recruitment or by promotion in accordance
with the rules of recruitment are senior to those appointed subsequently. In other
words appointees of one occasion are senior to the appointees of the next or
subsequent occasion/s if it is within the frame work of rules of recruitment and this is
what is known in service jurisprudence as seniority according to continuous length of
service in the cadre or grade.
(G.S. Lamba V/s Union of India)
1985(1) SLR 687 SC)
(1) Appointments can be made on a permanent (substantive) basis or on a temporary
(officiating) basis.
(2) Officiating appointment can be made substantive by the process of confirmation.
An official can be confirmed when the following conditions are satisfied :
(i) availability of a clear vacancy against a permanent post;
(ii) the period of probation / officiation of the official is declared to have been
completed satisfactorily
(iii) the official has passed the prescribed examination, if any, to the cadre /
post;
(iv) the official is the senior most eligible person in accordance with the
seniority list.
(3) An official appointed on substantive basis is senior to all officials appointed on
officiating basis in the same cadre of service or class of posts immaterial of the
length of service.
Rule 2(a)
(B.N. Nagarajan V/s State of Karnataka)
(197992) SLR 116 SC)
(4) Amongst the officials appointed substantively the interse seniority is to be
deiernuntjd according to the dates of confirmation but if it is the same, on the basis
or their interse seniority while officiating in the same grade and if not on the basis
of their interse seniority in the lower grade
(Rule 2(f)
(5) Amongst the officials appointed on officiating basis their interse seniority is to be
determined on the basis of officiation in the same grade and if it is the same, on the
oasis of officiation in the lower grade.
(Rule '’(c)
(N.K. Chauhan V/s State of Gujarat)
(AIR 1977 SC 251)
13
A't?
III. Seniority Between Direct Recruits and Promotees
1
A f'actor t0 be tal<en into account while determining the seniority in accordance
wit t ese rules in the proportion or the quota prescribed for direct recruitment and
promotion in a cadre in the Cadre and Recruitment Rules.
(2) Direct recruitment and promotion are possible only by the methods
and
procedure prescribed in the rules of recruitment.
r
(V.B. Badami V/s State of Karnataka)
(IR 1980 SC 156)
(3) When there is a quota, the quota cannot be altered according to the exigencies
of the situation.
(S.C. Jaisingani V/s Union of India
1957(2) SCR 703 SC)
(V.B. Badami V/s State of Karnataka
AIR 1980 SC 156)
c
<
(4) Promotions made in <excess of promotional
\
quota though not illegal are
irregular. The excess promotees have to be absorbed
---------- i:in subsequent vacancies
within their quota.
(S.C. Jaisingani V/s Union of India
1957 (2) SCR 703 SC)
(V.B. Badami V/s State of Karnataka
AIR 1980 SC 156)
Similar is the position in respect of direct recruits also.
(5) For the purpose of calculating the quota between the direct recruits and
promotees the period which forms a block is the period from the date of Cadre
and Recruitment Rules to the date of first direct recruitment. Thereafter from
the date of one direct recruitment to the date of next direct recruitment.
However, if there is an amendment to the Cadre and Recruitment Rules, the
period is from the date of Cadre and Recruitment Rules / recruitment to the
date of amendment and then from the date of amendment to the date of next
direct recruitment.
(V.B. Badami V/s State of Karnataka
.MR 1980 SC 156)
(2) to (5) above are covered by the Official Memorandum dated 5-7-1976
c
t
/o/
(6) The principles evolved in Badami’s case have been reiterated in Gonal
Bhimappa V/s State of Karnataka
(AIR 1987 SC 2359)
Instructions also have been reiterated by the Government vide Official
Memorandum No.DPAR 43 SRR 87 dated 14-12-1987.
Where the date of appointment of promotees and direct recruits is the same, the
direct recruits should be ranked senior to the promotees.
(Rule 3)
19-0 ■as
15
V )
/o^
IV. Seniority Among the Promotees
f
Promotion in one of the methods of appointment.
(Manager, Southern Railway V/s Ran^achari)
(AIR 1962 SC 36)
Appointment by promotion is possible by two methods, viz.;
€
(1) Promotion on the basis of seniority cum-merit; and
(2) Promotion by selection.
The seniority in these two cases is determined as follows :
(1) Promotion on fthe 'basis
* of seniority-cum-merit at the same time
a) If promotions are from anyr one cadre or class of posts, by their seniority interse
in the lower cadre or class of posts ;
(Rule 4(1)
b) If promotion are from several cadres or classes of posts of different grades, by
the order in which the names are arranged by the appointing authority?
C
n consultation with the Public Service Commission, where such consultation is
necessary, after taking into consideration the order in which promotions are to be
made from those cadres or classes of posts.
(Rule 4(iii)
(2) Promotion by selection at the same time ;
€
(Note . Now this is restricted to Heads of Departments and Joint Heads of
Departments in the same scale of pay).
«
Whether promotions are from the name cadre or class of posts or from several cadres
or classes of posts, by the order in which the promotees are arranged in the order of
merit by the appointing authority, in consultation with the Public Service Commission
where such consultation is necessary, subject to any special order of priority in
accordance with any special rules of recruitment.
(Rule 4A)
(3) Seniority is not the sole criterion. It counts only where two or more persons are
of equal merit.
(N.K. Panda V/s Union of India
(1977(2) SLR 589 (Orissa).
Seniority brings the officials within the zone of consideration.
(Union of India V/s Srinivasan
1979 (3) SLR 724 V Delhi)
Zone of consideration is 2X + 4 where X is the number of vacancies.
>
/^3
V. Seniority Among the Direct Recruits
The appointing authority has to determine at the time of first appointment : Rule 5(i)
(i) Where the recruitment is through a competitive examination, in the order of
merit.
(Rule 5(i) (a))
(ii) When it is by selection it will be in the order of merit in consultation with the
selecting agency.
(Rule 5(i)(b)
(iii) When successful completion of a course of training is prescribed, on the basis
of the order of merit,
(a) at the examination, if an examination is held ;
(b) at the selection for training if no examination is held. (Rule 5(i)(c))
(2) The above principles will apply when the selected candidates assume charge within
the specified period under rule 18 of the Karnataka Civil Services (General
Recruit) Rules, 1977, otherwise it shall be determined from the date of assumption
of the charge of the post. (Rule 5(2)).
(3) Within the specified period date of joining the duty is immaterial for the purpose of
determination of seniority and the ranking remains the same.
Syed Shamim Ahmed V/s State of Rajasthan
1981(1) SLR 100 Rajasthan
17
VI. Seniority on Appointment by Transfer
(I) When a person is appointed by transfer from one class or grade of service to
another class or grade of service carrying
carry,ng the same scale of pay, his seniority has
to
□e determined :
7
(0 if the transfer is in public interest, with reference to his first appointment to the
class or grade from which he is transferred ■
(ii) if the transfer is at the request of the official, he has to be placed at the bottom
of the gradation list of the class or grade of service to which he is transferred
as on the date of transfer.
€
e?
mority ot the persons already promoted cannot be disturbed. (Rule 6)
(2) Transfer does not mean freshi appointment,
administration cannot be held as <discriminatory.
Transfer in the interest of
(S.E.R. V/s M.P. Ranga Reddy
1992 92) SLR 346 Cal).
(3) If the transfer is on request, then seniority has to be assigned as on the date of
joining the Head quarters.
(R.N. Dhawan V/s Union of India
1981(1) SLR 855 Delhi).
(4) The seniority of the officers transferred from Defence Service, AU India
Service, a civil service of the Union or a civil service of any other State to any
equivalent class or grade of service in the State Civil Services also has to be
determined in accordance with para (1) above. (Rule 6A)
i
u
VII. Determination of State-Wise /
Division Wise Seniority
Where seniority has to be determined by
(i) preparation of a State wide list’consequent upon posts included in the District-wise
cadres being included in the State-wide cadre or posts included in the Division
wise cadres being included in the State-wide cadre, or
(ii) preparation of a Division-wise list consequent upon posts included in the District
wise cadres being included in the division-wise cadre :
it has to be done by taking into consideration the total length of continues service
in the district-wise or division-wise cadres, as the case may be. But when the length
of continuous service of persons in such cadres is equal then it has to be done by
taking into consideration :
(a) where such persons are promoted from a lower cadre, their length of
continuous service in the lower cadre;
(b) where such persons are directly recruited to the district-wise/division-wise
cadres, on the basis of their relative age, the older in age being considered
senior to the younger (Rule 7A)
19
KI
VIII. Removal of Difficulties
Cases m which difficulties arise and are not capable of being determined by the
apphcation of any of the provisions of these rules have to be determmed by the
appointing authority himself, in such manner as he deems fit, in consultation with the
Karnataka Public Service Commission (Rule 8)
f
<
20
t
M
Z0?
IX. Preparation of Seniority Lists
The seniority list for each cadre of service or class of post has to be prepared in
accordance with the provisions mentioned above, every year. (Rule 10(a))
(2) The seniority lists have to be prepared by :
(i) the Government has Gazetted cadres of service or classes of posts.
(ii) the Head of Departments concerned for the non-Gazetted cadres or service
or classes of posts. The Government may also prepare the senioritv lists for
non-Gazetted cadres of service or classes of posts. (Rule 10(2))
(3) (i) Seniority is a condition of service, hence every official has a right to know it.
the seniority lists are, therefore, required to be displayed on the notice board of
the office or are made available to the officials concerned for reference. If any
official desires a copy of the seniority list the same may be supplied to him on
payment of a nominal price of fifty paise per copy. They need not be published
in the Official Gazette :
—
(Official Memorandum No.DPAR 62 SRR 76 dt.9-2-76 and
Circular NO.DPAR 25 SRR 85 dated 27-7-85).
(ii) the seniority lists should be invariably prepared as on January first and
published immediately.
(Official Memorandum No. DP AR 45 SRR 80 dt. 29-9-1980)
(iii) the seniority lists prepared as on first of January every year should be
published before the end of February of the year concerned unless such an
action is prevented by orders of stay of courts.
(Official Memorandum No.DP AR 45 SP<R 84 dt.22-10-1984)
21
u
X. Seniority list for day to day operation in the event
of the existing list being quashed by the court :
I
The High Court of Mysore in the case of one Sri. Sunder Murthy (Writ petitions
No.25 and 137/1966) passed an order on 8-1-1969 to the effect that the pan of
ISS hst should be remade and until then status-quo should be maintained i.e.,
persons holding the post will continue to hold and no promotions should be made
on the basis of the impugned final ISS list without obtaining the permission of
court.
Subsequently, the High Court of Mysore in the case of one Sri. Kyathe^ouda
(W.P. No.888 to 891 etc. of 1969) passed an order on 26-8-1970 to the effect that
if the final ISS list is quashed either fully or in part the said list should be regarded
as available for carrying on day to day administration subject to the conditions that
m the event of the final ISS list rectified getting the promotions would be reviewed
on the basis of such a rectified final ISS list.
On the basis of three directions Government have issued clarifications O.M.
No.GAD 156 INS 70 dated 19-2-1971 to the effect that in the event of the final
ISS list being quashed it may be followed for carrying day to day administration
until rectified final ISS list becomes available whereupon the promotions should be
reviewed. Further, the Government have also clarified that in cases where there is
a specific directions of the competent court such directions or conditions will have
to be strictly complied with before taking any further action and the action taken
should be in strict conformity with the directions of the court.
r
M
MPROBATION
I. (1) Probation:
a) The preliminary time fixed to allow fitness or unfitness to surface;
b) A period of trail.
(2) Probationer:
One who is on trail.
II. The Karnataka Civil Service (Probation) Rules, 1977 Notification Dt:25th June, 1977
Gazettee Dt:7th July, 1977.
(1) ‘Appointed on Probation’ - appointed on trial - Rule 2(1)
(2) ‘ Probationer’ - Government Servant on probation Rule 2(2)
m.PERIOD OF PROBATION
1. Not less than two years excluding the extraordinary leave - Rule 3
2. The period of probation gets extended to the extent of extraordinary leave
automatically by the operation of Rule 3.
If the period of probation prescribed in the Rules of Recruitment is less than
two years then the provision in the Probation Rules prevails. - Rule 19(1)
4. If the period of probation prescribed in the Rules of Recruitment is more than
two years then the provision in the Rules of Recruitment prevails.
IV.EXTENSION:
1. Reasons for extending the period of probation has to be recorded in writing.
2. Governor/Government may extend by any length of time - Rule 4(1 )(I).
3. The appointing authority other than Government may extend by half the
prescribed period - Rule 4(1) (ii).
4. If the probationer has appeared fcr departmental examination during the
prescribed or extended period of probation the period of probation is
automatically extended by the operation of the provision under rule 4(1).
I. Until the publication of the results, of examination if he passes ; or
II. Until the publication of results of the first of the exams in which be
fails.
23
u
(
v. REDUCTION:
1) ^aTdTscharoed
Wh'Ch the Proba4er
I. of the post to w’hich he is appointed ; or
II. of a post the duties of which are similar and equivalent - Rule4(9)
f
2) The effect of the above provision is that in respect of Item (I) above the reduction in
pracuce, cannot be more than half the prescribed period and in respect of Item (ii)
above u can be any period even upto the entire prescribed period.
3) Since the rules provided for extension as well as reduction of the probationary period
the presenbed period of probation cannot be hold to be mandatorv - (Aiit Sin^h V/s
State of Punjab - SLR 1983(2) SC(1).
J
r
VI. DECLARATION:
At the end of the prescribed/extended/reduced period of probation it is obligatory on the
po?t ° Rul a5PP°intinS authority t0 consider the suitability of the probationer to hold the
If it is decided that the probationer is suitable, then the period of probation should be
declared to have been completed satisfactorily. - Rule 5(1) (a).
r
€■
Matters which can be taken into consideration for adjudging the suitability:
I. Work and performance and service records duriing the period of probation;
II. passing of test/examinations prescribed if any, during the period of probation.
VII. DISCHARGE:
If it is decided that the probationer is not suitable to hold the post, then it may discharge
the probationer - Rule 5(1 )(b).
(
Matters which can be taken into consideration for discharging the probationer:
I. Performance and service records;
II. not passing the prescribed tests/examination
Matters other than work which can be taken into account to discharge the probationer:
24
///
I.
Attitude or tendency - example attempts made by a probationer to secure a job with
better prospect elsewhere (Case Law, TCM, Pillai V/s Technology Institute. Guindy AR 1971 SC 1811).
II. Behavious or conduct - example the conduct which is not in keeping with the status ot
the Govt., Servants (Case Law: Kumar Chandra V/s State of Karnataka - ILR 1987
K.AR 2756);
Mis-conduct which has resulted in punishment - A Producer in Al India Radio who
committed mis-conduct indulging in loose talk and using tilthy abusive language
against Station Director. Here the mis-conduct is only a inducing factor for discharge
and discharge is not a direct punitive action for that mis-conduct.
VIII. DISCHARGE DURING THE PERIOD OF PROBATION:
A probationer can be discharged even during the period of probation on the grounds
arising out of the conditions imposed by rules/orders of appointment or on account of un
suitability - Rule 6.
Orders of appointment may be subject to certain other conditions like; Investigation of
antecedents or physical fitness or subject to legal proceedings pending in the Courts.
When these conditions are not satisfied by the Probationer he may be discharged during
the course of probation.
Unsuitability is another aspect on the basis of which the probationer can be discharged
even during the period of probation.
However, when discharging person under rule 6 an appointing authority other then
Government should obtain the approval of the next higher authority. This is to avoid
prejudice resulting in malafides.
Recourse to rule 6 cannot be had when misconduct is alleged. If misconduct is alleged it
amounts to removal or dismissal within the meaning of Article 311 and hence the orders
passed have to be in conformity with the Article 311(2) i.e., recourse should be had to
CCA Rules and not to rule 6 of the Probation Rules - Ref. Rule 7 and also the Circular
No........................Dt:.............................. ).
(Case Law: Anup Jaishwal V/s GOI, SLR 1984 SC 426).
LX. GENERAL ASPECTS OF DECLARATION AND DISCHARGE:
1) Under these rules:
I.
Any delay in declaration of probation does not give rise to automatic declaration since
there is provision for unlimited extension;
25
//^
here the rules provide for fixed period of probation and limitAd
• •
pension or n0 provisio„ „ a||
„tension [hen
d
Provision o.
Gov, serven, is c0„tlnued the perlod of
a[iori , Pd2 ° . h T'
I
deemed to have been
automatically
Germed
declared.
(Case Law. Kumar Chandra V/s State of Karnataka - ILR
1987 KAR 2756)
of a probationer who was already in Government service prior to
aPPO^ment as probationer results in his revers.on to that earlier
service or post (Vide
Note below rule 5).
IV' wnVr0,b’tioner Charged under rule 5 or 6 has no riuht of appeal Th.r ' ■
u
words the order once passed is final - Rule 8
“
P
That 1S in Other
~
f
nr6"'’ thlS Pravis,on in the
do not bar the judicial serutinv Th
P obationer is not prevented from approaching the Court or the KAT h, rTh S affeCted,
‘ ter*rence by the judiciary is limited to verifying whether the dischara '
Ot
or othenv.se. Unless there is a prima-facie evidence in the ordeTpa! H
T
■eadmg to the orders that the discharge is other then discharT T °r reC°rdS
cannot interfere However if
d char^e simplicitor the courts
that •
rere- However, if there is evidence to show on the remrHc
h«. mscounducr is alleged and stigma a,.ached, however innoouo °?h
t
he final order of discharge .he Corms can ask for the producli™ „f ‘
?
8
and examining the matter.
oauction of original records
(State of Maharashtra V/s Saboji - .AIR 1980 SC 42)
C,
X. CONFIRMATION
confinned aTth"
Probation a probationer is ent,tied to be
the
Rule 9.
H earliest opportunity im a substantive vaccancy that may exist or arise. -
XI. INCREMENTS AND PAY:
SXSrt:r~; ss “a;==
extended period of probation. - Rule 10.
After the expiry iof extended period on declaration of «
satisfactory completion of
probation, as from the date the declaration taken effect,rhe probationer
s pay has to be
fixed notionally taking all the increments due to him for the entire
service but he is not
entitled to any arrears of pay. - Rule 10.
26
(
//5
XII. WHERE JUDICIAL PROCEEDINGS ARE PENDING:
Where the appointment of a probationer is questioned and Judicial proceedings are
pending In a court of law, if the prescribed period of probation is over and if he has
otherwise satisfactorily completed the period of probation, the same may be declared and
he may be given consequential benefits subject to final disposal of the said proceedings Rule 11.
9
27
(>
/7Z/
HgTTREMEXT DENEFITS
Cl- P
Cyj
a- (
Every Government employee who enters
service has to retd re
from Service. On retirement
an employee governed by the
existing
pension scheme gets a i— . - monthly payment of pension for life and
a
lumpsum gratuity at the time
of his retirement determined with
reference to the length of service.
I n the event of death of the
Government Servant, his
family gets under
certam conditions a
monthly Family Pension for life.
To ensure that
an employee’s family gets all retirement benefits in time, it is r
essentral that employees acquint them,selves with
xules^ and procedures
- etc. in this behalf.
is
pensionary’’ benefits is
service.
is available In employ,
s
nh1' ’
ple=e of
employee
’
s
Service
Dock/
.
rvic- Book/oexvrce Record.
S^rvi '•=>
< • ~ stares as
soon
as
an
employee
enters
service
and
all
imZor
’ZZ
as soon as an employee enters
events such as
as confirmation,
confirm.-,^,xntoor.ant
promotion,
,
- crant of m increments,
ave e c., sanctioned and tlie total length of
re=ora.a m it.
°£ service are
ieng^^f
verification of entries
made in the Service Register b-u- +-b=
■>
y-^-suer oy the employee.
He should insist on
Service Book entri^c
trx*s once a year, without fail.
Eligibility for Pension ;
A Government emplOyee in
a pensionable service, including
qua si-perman ent or temporary employment,
j retiring on superannuation
after rendering not less than IQ
years service is eligible for superannuation pension.
1. The Government
servant is required to retire from service
years, which is at present.
The retirement
acmally takes e£fect fro™ the afternoon
of the last day of txhe montl;
in khlch he attains the age of 58
years. Hov/ever, the o
retirement of a Government
servant whose date of birth falls on t
first GLf day of themonth
frem the afternoon of the 1 ast
day
of the month
on attaining the age of 58
the month ln which he atlaias ae
58 years,
-J
the case o£ a Ooveth^ent servant vho puts in a euall-
fying service of not less
-zr6 completed
,
"
->s than O
six monthly p~r<ods
(33 years),
e pension will be calculated at 50 per cent of the
employments drawn by him
□t the time of his *
4 retirementFor a
retirement..
Contd...2
=»en-e„t se„Mt
r.
i
Z/3
-2-
at the time of his
^^UfWtg 3ervlce c£ 2Q
retirement, renter.
completed
six
"o'>thiy PWM3 or;or_
SSS than 66 completed
six monthly periods.
S ?e"-'ton "HI
be in
!„ eueb
will be
the amount of
pension.
n Proportion of the
The pension ;
maximum admissible
-1 sc ca:
■ ated will bo
of Rs. 390/subject to a minimum
and ^^xirnum of
^•3450/- P^m.
2-Amount
Gratn-ft on
^etirement:
In the c^se of
a Gov e rnm an t
less than lo
six raonthly periods servant, who has completed
not
of Qualifying
retirement
service, the 3iuou n
gravity admissibl
completed s4 -A.
x
e *3 V4 of the documents for
Hionthly period of ,
eac
niaxiniura of 1g 1 / O x. •
Qualifying service
tines
the
subject
to
a
S th~ SrioluiT'entsXsubj
Of Rs • one lakh).
ect to a
overall maximum
f■
-^vernment
sdinrr
-wwea -to jeonarnu te a
P^JCtion of his
sai®9’One thir for ->
pension
Parent.
As par thexisting
' ^-^e^ent
-servant has xn
xdie time of reti
Ornish a
otherwise' tO co^ute pension,
t regarding his
intension or
is made, the Accountant General
cases where no
such declaration
will presun® that
Government
servant has opted for
tl'e retired
maximum commu fc=> <-•<
under the Ruie
—‘s and authorises c<
and DCRG.
value dlongv/ith pension4
lhe commuted
Portion of the pension vzill be
15 years from the
date of coitutri ta ti on •
after
4«Fcr £sgliies (a)
j^eath Grata, ■?
I-" the
event of death of
service, the Death Gratuity is a Government
servant while in
admissible
length of -^Idlifying Service
at the following
rates:
iess than
Or-e year
Sate q-f Oratuitv
One year
Two'
• feiiioiXinen ts
■ i-han f ive or more bit -less
Six times of
y-sars.
emoluments
Five years or
than 20 years. more but less
Twelve times of
emoluments
Twenty years or
more
Half of enu^iUrnerit
t
f:inrn
Plumer,ts and subject0
to a t.axlfcm ct 2.5 13khs)
Contd. .3
-
—3—
5. (b) Family Penci on
Family Pension becomes payable to the
minor sons/unmarried minor daughters, from the : widow/widower or
day following the
date of death of the employee while in
or after reti ec era ©nt. It i3 payable only to one member service
of
the family at a
time. Tne rates of family pension
adzni ssible are as under:
Emoluments
1) Kot exceeding Rs. 1500/-’
•p.m.
ii) Exceeding Rs. 1500
but not
exceeding Rs. 3000 p«m
ill) Exceeding Rs. 3000 p.m
30% of emoluments subject
to a minimum of Rs. 390/-p.m
20% of emoluments subject
to a minimuF". of Rs.450 p.m.
15% of emoluments subject
to a minimum of &.600 p.m
and a maxinum of Rs.1250 p.m.
In case Ox Government
a.fter having rendered a cu"!'' •c-- servant, who dies while in service
r.g service of not less than 7 years
the Handly pension admissible will
be
at an enhanced rate ecual to
50 ’
Per cent of the emoluments last drawn
or tu-ice the family pensio:
normally admissible, whichever is less,
till che date on which the Government ’ for a period of 7 years or
servtint would have attained
of 65 years, if he had survived,whichever is
earlier.
In tne event of death of both
-he fatner and mother who
were government servants, the family pension
payable to minor
children> is subject to a total of fc.1250
p.m.
6. Other Types of pension:
a) . Compensation Pension: This pension is
5**anted to a Govern—
rnent
servant who is discharged from
public service on the abolition
of his post.
is g„nted to a Government
authority to
-t>e poxTEcinenxlv
_
jr ■■
=tpaci^ateo for further service.
~^-^l£l£S_Per^ion, Retiring Pension is
a Governmeet servant who ±s retires voluntarily or i- reti-ed
advance
the age of retirement by giving notice.
‘
r ■'S<’C13red by *'he
TCSi=al
of
'rhi=
i= awarded in the form
pension' K>PZnGe°”~S.■nt'ler"' °£ ’ Govcrnoent
serx'antof
or a disabilitv
or,,c/emms.it servant under the urovision
--------f: K«G.£.(Extra□ rdinar^- pension) Rules 1980.
Cn-' t
. 3
-4c) In respect of a Government
for mis-conduct, insolvency or in
Servant dismissed or removed
-efficienty, compassionate allowar
not exceeding 2/j of the pension which
would have been admissible
baa tile Government servant retired
on medical certificate may be
granted in cases deserving special
allowance is treated as pension for consideration and such an
purposes of commutation.
7. Condition for
grant of Pension-
future good conduct is an
implied condition for grant of
pension and its continuance:
The pension sanctioning authority,
"ay, by order in writing whithold
or withdraw pension or part
the_eof.
Whether permanently or for
pensioner is dua convicted of
grave misconduct.
r
a specified period, if the
serious crime or is found guilty of
i'
SchcdulQ rirp tm’
Lender--:------ ^^^a^ation^L^ettlement
pensionary benefit:
---------------------
i) After ccmpletion of 25 vea-*'
4
office of theOffice where the Gov
He"d
forward the service book of the Go
Servant iE working will
Officer for ver^i-'atlor
r
'5srnn'‘ent servant to the Audit
aeterm.in.d by t^ Ldit Of fleer. cornriTunlcate trie salifying service
:er.
I
i-) The Head of the Office will
4
co tain urom the re ti nine
Non-C-azactad Government servant th,-.
Particulars mentioned in the
Proforma appended herewith one
year before the date of his retireme nt.
This proforma and the particulars
mentioned therein will be
sent along with other pension documents
^be Accountant General
not later than three months before
the date of retirement of the
Government Servant.
Tha Ga=ett^ c=v,rr.»ent
servant will submit
' -e prozerma one year in advance of his
retirement to the Accountant
General who will build up his pension
records.
• Dcouments to
accoccany Pension papers :
Upon the retirement or the c^^vsrnmer. t o.rvant/
the folio—
wing documents are required to be
sent to the Accountant■ General
within a week from the date
of retirement:
a) Last Pay certificate duly noting the
amount to be recovered
from DCRGj such as MBA,
MCA and other advances, it
if any.
b) No cue r
’
cefei fxcute duly no ting go'emment dues other than
those noted in the LPc which
-------1 are to l>e recovered from cut of rhe
^’^"^tuity payable to the
pensioner.
In order to get pensionary benefits.
in time please ensure
Con td. • 5
// e
—5-
that i) Nomination for DCRG is
ii) Necessary verizicati
Vi’ars of service. iii)
of service is done after completion of
Required particulars in the
prescribed proforma are submitted to
the Head of Office one
year before the date of retirement, i v) The
proforma along with
particulars mentioned therein are forwarded to
the Accountant General by the
before the date of retirement -eau of Office atleast three months
to Accountant General irimodiA elcng with N.D.C. V? lpc is scnt
fely after retirement*
10. Preparation of Family Pcnolor, Papers.
In the case of death of the Government servant,
while in
service, on receipt of Information of the death
servant^ the Head of Office will send a lettQr ox the Government
to the family of
the deceased government servant in form
C requesting the family to
furnish the relevant pa^cicul ars (both
rorms appended to this breff)
fiUs ^11 enable the family msnbers
Get family pension in time.
11. Anbicipatory Pens!on •
Where it is not possible to forward tho
to the AOTOl.tont 3eneral< „^hln
tt.e.-.exon records
of Office will dta„
iiba_.o
' ‘
scrlDed ttoe limit. Head
“■ dl£f'Sr“’:
perentage of last pt,y „ith
Of e qualifying service.
""
nu“-Der °f years
Anticipatory Deatn-cum-?.ef;.ranent
G i. a zu 1 ty cun h! so be p ai d
to the pensioner at the rate of half
month’s pay for each completed
year of qualifying service subject to
a iuexlsaum of 15 months pay.
A2- Voluntary Retirement;
A Government servant may be per^feted
to retire voluntarily
time on completion of a
□ qualifying service
of not less than
yea.s. A Government servant mav ai«^
be permitted to retire
voluntary any time on attaining tnc
age of 50 years.
Government
servant who is permitted to ratira volubly
any time on com pie tic
<■>*- a qualifying andee of not la53 tnan 15
yr5 is allowed
weightage upto 5 ye=rs(Ft>le 285 (1)
(a) cf ZCSRo). However, rhe
benefit of weightace is not 3.±r.i.£ihic
to a Government servant whp
is permitted to retire vclunarily
o---'r time or, attaining the age
of 50 years (rule 285(1)(b)Of Krgts).
Cor.td.. 6
13.
-6fretirement in Public
/'7
interests
Government may retire
any Government servant, in public
interest any time after*
completion of 25
years qualifying service
or after he has attained the
age of 50
years in the case of a
Government servant holdin
g a Group a
or Group B post and case of
a government servant holding
a Group G or a Group D peat.
The pensioners are also
entJ.tled
’'O me-ical attendance and
"to different cla 3eis of
oseta of accommodation
^or treatment in Hospitals
and Sanatoria as indicated below:-
All General and Special
Go verrunen t H°spi tals.
.Monthly pension liml*
1« Hot exceeding Rs.500
2. Exceeding Rs.500 bjt not
exceeding 3s.750
■S^ceeding Jb. 750 .but 'not
^exceeding Rs.1250
•4. -Exeeeding ^iaso k^t not
5. Exceeding Rs. 1500
1 • Mot exc eeding
Rs. 500
Class of uacomniodation
General Ward
fc*5 ward or any ward just
below Is. 5
^•5 .ward or cxny wax'd just
below
Rse10 ward or any ward just
below Rs. 10.
^•20 ward or any ward just
below fe*20.
Sanatorium
Mysore
N a fayan a s wai ny Ward
Rs.l
2. Exceeding Rs.
Second class special
500 hut not
w^rd ft. 4 cr
exceeding Rs* 1250
Just below Rs.4
3. Exceeding B.l250 F1„t class
v.ard Rs. 6 or any
ward just below Rs.6
Other
Sanatoria
4-
B Class '7a.rd Rs^l
A class ward Rs. 2
any ward Just
below Rs. 2
t
Special ward Rs. 5
or any ward just
below fceS.
i
-/J?.....
SYNArilC- NOTES ON TA RULES AND RETIREMENT
BENEFITS
■BY SRI . VT LWANATHA N gTEr ACCOUNTS OFFIgER-CUM -F.A«
H.&,F.W. DIRECTORATE e BANGALORE
r* PlaBsiflcation of Government
Travelling Allowances--- — aervanta for pirposes of
The existing classification
purposes of travelling allowance
of Government servants for
shall be revised as under:-
Category
Pay range (Per month)
I
II
III
fa. 3300
and
more
fa. 2150
to
fa. 1520
to
fa.1520
fa*3299
fa.2149
IV
2.
Below
Entitlement for Travel By Rall»
The entitlement to railway accommodation of Government
servants for journeya on tour or transfer shall be regulated
as under:-
Category to which
-S^Xgn^gnt^sery&ntjg^^belongs
Entftlement
■——————
I
(a)
(b)
those drawing pay of
fa<>4325 or above
those drawing pay of
fa. 3300 or above but
below Rs.4325
II
III
IV
3«
I Class/AC
I Class/AC tow
Tier sleeper
I Class/AC two
tier sleeper
I Class/AC Chair
Car.
II Class f^eper
Daily Allowance :
State theF?^vi^^Ocla^i^ailLallOWnnC* for halt» within the
c^r/3117 aii°—h^rcuSS^r^trshix £vised
Contd.♦2
K >
/a/
-2Halts
Ca teg or;
to whicl
*Govt*
servant
b(?.l on gs
wrEHTn~"
B’lore
I
0 ther
0 ther
cities
Place s
with
municipal
Corporrations
fee"
Rs.
110
90
I±
80
III
65
55
45
40
TV
C73r
4
Halts Outside the
State
StaCe
Ahemedabad,Bombay
Calcutta, Delhi
Ghaziabad.Hyderabad.
K“PJr, Lunknow,
Musaourie
Nagpur, Pune, Simla
Srinagar.Goa,Diu
and Daman
“
65
Other
Places
----------------------------------------------------------
’
70
135
110
55
110
80
45
90
35
65
65
45
ot»
Special ^^-°f_dMly_allowa
r ',
nce for st
—il^^Aiahmen t
of icurn? St>a<=ial r’t'S °£ dally
- -
halts In
re spect
the state< ln ,
cn./n, o„ tour
or other registered
,r^’12taent PrOvidl1” ^ing and/or lodging at scheduled tariff
shall be revised as under.
C a. te go ry
to which
Goverument
Servant
belongs
Places of Halt
chT^?3^* Bon*ay, Calcutta^ ~D^lhi
Chaziabad, Hyderabad, Kanpur,Lucknow
Nagpur, Madras, Mussourie/plne
Srinagar and Goa, Die, & D^nan
*Simla
Other
Places
Outside
the State
fo7
I
II
III
250
200
200
150
150
IV
100
125
°n tcur_by Air*
A Government servant
drawing a pay of fc.4325 or above shall
entitled ■to travel by air
for Journey on tcur outise the
State.
A
servant drawing a pay of Rs. 3300
or above shall
entitled to travel by air for
Journey on tour
within the State
the •places <connected by the Indian Ai rl ineg
th*- vdoot Services*
Services, including
^3^
A Government servant drawing a pay of RS..33OO or above
pcsedxng on duty on tcur from Bangalore to any place in Bidar
Di-'cri.ct/Bangalore to Gulbarga and vice-versa is authorised to
by sir viu Hyderabad.
Jeurney_by Air on transfer :
A Government servant drawing a pay of Rs.4325 or above is
'L. ■' ti tl emen t to travel by air(including Vahudoot Services) on transfei
and claim one fare for himself and an additional fare for each
member of his family.
; r —?-rJ-nsfer Grant i
The classification and the rates of cy transfer grant
admissible to a Government servant on transfer in public interest
t
invoirving change in headquarters,
shalx oe revised as under:
from one station to another statior
Rate of Transfer grant.
Category to
which GovtS.:«rtTa,nt be
long«.
For transfer within
tlae District
For transfer outise
the District
I
Rs*
1200
ft.
2000
II
900
1500
III.
IV
600
1000
300
500
8
HHgage alloance for journey on transfer by road by owned
^L?._2r hired taxi:
A Government servant drawing a pay of Rs. 2375 or above may
on transfer in public interest, undertake journey by owned car or
oy taxi and may claim single mileage allowance at the rate of
3-00 Per K.M. irrespective of the number of members of his family*
9. Road Journey
*Ihe ra te s
Mileage allowance t
of road mileage admissible to Government Servants
Contd*•4
/o/J
-4-■’-n
r<
3.
■ooct of road Journeys in owned/hired/borrowed conveyance
»
down in -he rule 451 Karnataka Civil Services Rules
be as follows:—
When jcumey is performed by
C <3. co gory
Bicycle/
Foot
30 paise
per K.M.
Motor Cycle/Scootsr
Tonga Cycle-rickshaw
Rs.1.00 per K.M.
Full Taxi/
own Car
Auto- ”
rikshaw
fa.3.00per KM
2.00
per K.Mo
subjecl
to a
num Ks.
XI
—do—
-do-
-do-
-do-
III
-do-
-do-
•do-
IV
—do— g
-do-
-do-
-do-
-do-
In respect of road marches exceeding 100 K.M.s a day mileage
allowance shall be admissible at a uniform rate of Rs. 3.00 per K.M.
?-n respect of Journeys performed by motor car and Rs.1-00 per K.M.
in respect of Journey performed by motor cycle/Scooter.
,
J?’ ^asportation of personal effects on transfer by enqaqlnc
h._ILL-o-e railway wagon or container services
A Government servant drawing a pay of fa.3300 or above may*
engage a whole railway wagon or avail himself of the facility of *
the container service provided by the railway service.and
10c Road mileage for trans
-P_rjiS_ga not connected by rail:
■Pergonal effects betweex.
A Government Servant on transfer shall be entitled to
draw road mileage for transportation of his personal effects of
•tne minimum permissible quantity, between places not connect by
railway at the following revised rates:
Category of the
Covt. servant
Rate per K.M.
Rs. ps.
I
10-00
II
6-00
III
3-00
IV
2-00
t
/
^5-
Hr Incidental Charges:__
The computation of daily allowance on tour or transfer
5h-.ll begin when a Government Servant actually leaves his Headquarter
-nd ends when he actually retu rns/reaches to the place in which his
hecdouarters are situated whether he halts there or not.
12e Reimbursement of actual cost of transportation of owned
.CPnveyance on transfer:
A Government servant on transfer may draw the actual
cost of transportation of owner’s risk conveyances on the following
scales, provided that the distance travelled exceeds 120 Kilometers
and th^t the Government Servant is travelling to join a post in which
possession of a conveyance is advantageous from the point of vi^w
of his efficiency.
Fay range
Vehicles allowed
Rs. 3825 or above
R5«.164O or above-bat
follow 8s. 3025
Below Rs«1640
13.
A Motor Car or a Motor Cycle
A Motor cycles/Scooter/
Moped or a Cycle
A Cycle
Travel concession to home town x
A Government servant drawing a pay of Rs. 3825 or above
may after obtaining specific and prior approval of the competent
I
authority, undertake journey in his own car namely, by car registered
in his own name for joamey to home town between places connected by
railway under the scheme of travel concession for journey to home
town and claim (a) first class railway fare for himself and the
members of his family or (b)
single mileage at Rs. 3-00 per K<M. by
the shortest direct route,
irrespective of the number of members
of his family, whichever is less.
• ^jr2S^.J^_ravel Allowance:
The fixed Travelling Allowance sanctioned to the
rollowing categories of posts shall be contined at the rates
Indicated against them for a further period of one year from
Conid.•6
\ /
1-9-1 7? or until further orders, whichever is earlier.
le
Junior Health Asst.
(Male & Female)
2. Para Medical Workers (Leprosy )
. . Rs.100/- p.m.
Rs. 125/- p<m.
(
The Officers/ Staff who have been provided with Government
vehicles for Journey on official use will not however be el 1 gtbel a
tor .Fixed. Travelling Allowance®
<
t
i
*
I
PENS ION
Classification of pensions: ( Ru I« 258
1 .
Compensation pension
2.
Invalid pension
3.
Retiring
of KCSRs1
peosion
Superannuation pension.
1.
Compensation pension:
(Rule 259
of the KC8R3 . )
A Government servant selected for discharge from
service owing to abolition of
(a)
a post may;
be appointed to another post* t he
c □ nd i t i □ ns
of which are deemed by the competent authority
to be equal to those of the post held by him;
r
(b)
be g i v en the option of taking any compensation
pension or gratuity to which he may be entitled
for the service already rendered;
(c)
be given the
or
option of accepting another
appointment or
transfer to another establish
ment of lower pay.
2.
Inva I j d o ens i o n:
(Rul e 273 of the KCSRs.)
An invalid pension is awarded
servant who is allowed to retire
mental
infirmity, which has
due
to a Government
to b od i I y o r
rend er ed hi m permanently
i ncapaci ta t cd :
or
(a )
for
the public
(b )
for
the particular branch of it to which
he be Io ng s.
service,
2
3* —9tiring pension:
(Rule
_2 85 of the KCSRs)
A Government servant may ;
(21 )
be
permitted to ratire any time after
completion of qualifying service of not
less than 15 years;
(b) be permitted to retire
the age of 50 years;
r
any time on at tai ning
(c) be retired £n
public interest any time
after;
<
(i)
completion of 25 ye^rs of
Tua 1 i f y£ eg
s ervi ce; or
(ill attaining the age of 5o
.
/ears in the
case of Government servant holding a
Group-A or a Croun-B post; and 55
years in the case of Government
servant
holding a Group-C or Group.D
Dost.
•S.»Perannua t j on pension:
(Ru i «
of the KCSRw)
A Government servant compulsorily retires
on
th® afternoon of
the last day of the
month in which
h<= attains the age of 58
a year s ;
Provided that the date
of compulsory retirement
of a Government
servant whose date of birth is firat
daX of the month shall be the afternoon
of the last day
of the month preceeding the month in
which he attains
the age of 58 years•
3
QUALIFYING SERVICE
II
(Ru I e 220, Rule 222 and Rule 224 ,A of the KCSRs)
(In respect
of Government servants whose retirement
or death takes place □ n or after first September 1968)
(1) All services under
the Government whether
temporary or permanent rendered after
attaining the age of 18 years .
(2) The services must be paid for from the
consolidated fund of the State Government.
PERIOD OR SERVICE
III
(Rule 244 A of the KCSRs)
( In resoect of a Government servant whose retirement o r
death takes place on or after first September 1968)
Time passed on all kinds of leave counts as
service under all
circumstances;
Pr ovid ed that the maximum period of leave without
allowances to be so counted is restricted to three years
in the entire service.
IV
SU 3° E NS IO N, RESIGNATIONS AND BRAKES IN SERVICE
(Rule 250 a. nd Ru 1 e 252 of the KCSRs)
Suspensi on:
(1) Time passed under suspension if on
conclusion of the enquiry. Government
3 ervant
is fully exonerated or if the
susoension is
held
to be
who I Iy
/i-7
- 4
unjustified,
counts for pension.
(2) Time passed under
suspensi on i n other
cases does not count unless the authority
competent to pass orders under rule 99
clearly declares that it shall count and
it shall count only to such extent
as tthe
competent authority may declare .
Resignat iona:
Resignation entails
f or fei ture of oast
service;
Provided that
resignation with proper permission
to take-up another appointment shall
not be treated a 3
resignati on
af public service.
Di smi s sal or rem.ova 1;
€
Di smi s sa1
inefficiency
or removal for misconduct.
insolvency or
not due to age or failure to pass a
prescribed examination entails forfeiture
of past s ervi ce.
C
<
/3 o
-5-
CALCULATION
1)
2)
OF
RETIREMENT
BENEFITS
PENSION
(L'ast Pay drawn)
X
2
X
(Completed six monthly
periods of qualifying
servi ce )
66
DCRG (Death -cum»retirement gratuity)
(Pay ♦ DA)
X
(Completed six monthly periods
of qualifying service)
4
3)
CVP
(Commuted Value
of Pension)
(NOTE: Year of purchase as
a s per
rule 380 of the KCSRs)
(Last pay drawn)
X
12
3
X
the
table given in
(Commuted value in
number of years of
purchase)
J- ;
. £ -
4)
PEG
(Peoaijo eguivalent of gratuity)
1
DCRG
12
x
(Connmited value in number of
years of purchase
Commutation table under
rule 380 of KCSRs.)
(
5)
Encashment of EL
(Pay ♦ DA)
X
(EX. at credit to a
maximum of 240 days
i•e• 8 months)
.1
c
L
■ I
-l-lf...
328
‘ I commutation table
329
COMAfUTATtON VALUES FOR A PENSION OF
R£ 1 PER ANNUM
Age
next
bi rd)day
Commutation value
expressed as
number of
years' purchase
Age
next
birthday
18
19
20
19.20
19.11
19.91
Commutation
expressed as
n umber of
years* Purchase
rt
■
Rs. P.
52
12.66
53
| 40
12.35
54
12.05
55
11.73
56
11.42
Commutation value
expressed as
number of
years* purchase
74
15.87
75
.I?
15.40
22
18.81
57
18.70
H.10 J
58
10-78 .
59
60
10.46
10.13
I
I 47
14.10
61
9.81
I 48
13.82 »
13.54
24
25
26
27
28
29
30
18.59
18.47
18.34
43
|
62
9.48
I
I9
18.07
63
9.15 J
50
17.93
64
8.82
17.78
65
18.21
L
15.15
14.90
14.64
46
51
73
16.09
18.01
44
72
16.31
15.64
-
Commutation value
expressed as
number of
years* purchase
Rs. p
16.52
I 41'
|
Age
next
birthday
Rs. P
21
23
14.37
13.25
12.95
76
77
78
79
80
81
82
83
6.30
6.01
5.72
5.44
5.17
4.90
4.65
4.40
4.17
3.94
3.72
3.52
84
3.32
85
3.13)
8- 50 ~|r-’-38
---------- ---------- --phlch the pinTlonT beX6^^61031^61^3^
32
ry or Bank
17.46
being
67
7.85
P“ 3S2. If the
''S l° bC dra'Vn33
17.29
^‘“’utaUon became
abslhu^b
1)16 day °n whlch
Pensioner
dies
68
7.53
34
17.11
-ue
absolute
but
value, this value shin h
. ' reCClV‘ng a‘C comm^
69
7.22
35
value shall be
16.92
383 Th r n
IO hlS
. I
70
6.91
36
,
• The following
J
infi renui-uj
regulations
16.72
^lation
of
pensions
afe
fo
T
80VCniln
S
P^edu.e
for
die
71
6.G0
pensions are f
*>Uons for commutation of n/T3”"
CaS“ *n Whl^
commutation of
SubstHulcd by
N^- I'D 34 sns 71 dutcd I4.GJ97J (uvf 1.9.1 971).
a.
pension arc made under theie
31
1.
19.28
'wthday
I 38
I 39
Rs. P
17
[ DCXt
17.62
66
8.17
’ For (hc sPm'e eonc^ CO"UnU,aUon of P^sion. if tJ0
CovLnmem
concerned a Government servant sha'u
;•<
If
?
f
< /
(3)
or. U THIRUNaVUKIO'-’
'J
/
^fufu^or &
Oflpa'tlueHl
ft ''' '
■
Ucoi.’i'-U.
------ •'
• *
'
licammation of injured person should be conducted in good
light.
In every examination of Medico-legal case the written, free
and voluntary consent of the injured person should be obtained.
If the injured person is below 12 years, consent of the parents
or gaurdian should be obtained.
Mention the date, time and place of examination and brief
history of the case and the time of assault or Accident and by
whom the history is given.
It is necessary to mention two identification Marks on the
injured for the purpose of identification of the person in the
court of law, along with other particulars like the name, age and
the address of the injured.
Describe the injuries found on the body as to the nature of
injury, exact location, exact measurement in Cm giving length,
breadth and depth if applicable,
Mention shape of the injury,
and draw a rough sketch if necessary.
Colour of the contusion,
edges of wounds in case of incised and
lacerated
wounds.
. and stab
Mention signs of vital reaction, like, bleeding, clot,
infiltration,swelling of the edges, sign of inflamation and in
fection of the wound if any.
Details of General condition of the injured on systemic
examination with regards to pulse, blood pressure, pupillary
reaction and level of consciousness etc., to be noted down.
hny
investigation done such, as I-ray examination to be mentioned.
Furnish the opinion, with regards to the nature of the
injuroies found on the body of the injured.
Mention the injuries
which are simple in nature such as contusions and abrasions, and
VUjk. - -
ur. U.
& !•:a JO cJ
MEDICO LEGAL AI;TO?SIU>
j
i.nuuc of ■.•□rofi-lc
•«< —
riouirltcl. 2 -S«.C.
Post Mortem report or Autopsy report is an important
Medicolegal document in the court of lav?.
legally invalid.
Incomplete Autopsy report is
I£ a complete autopsy is not caroled out by the
Medical Officer, evidence which later may be proof of great Medico
legal importance may be invariably lost and as a result, the course
of justice may be impeded.
It is therefore essential that in all
cases, the
-autopsy should be a complete one. The responsibility of
carrying out a complete autopsy rest soley on the medical officer.
Wles for Medico-legal autopsies
(1) -edico-legal autopsy should be undertaken only when there
official order authorising the autopsj' from the police
is a a
or a Lagl-
strate.
fS) The Medical officer should first read the inquest
report carefully and findout the apparent cause of Death from
the brief history
of tne case and circumstances □f Death.
If the same is not furnished
in the Inquest report, the investigating officer should be
requested
to furnish the same.
Co) fhe 1-ost Mortem examination should be conducted in day light
and
not m artificial light as far as possible, because colour changes,
such as Jaundice, (colours of the contusions and Post Mortem stains
etc., cannot be appreciated in artificial light.
IJo unauthorised
person should be permitted to be present during autopsy.
(4) Hie Post Mortem
Mortem should
should be
be as through and complete.
(5) Identification of the body is very important, must be identified
by the Police constable v.ho accompanies the body and the
aa:Le and
Constable number must be recorded.
If the body is unidentified, the
marks of identification on the body and the clothings briefly described.
(6) The external examination should be done very carefully from top
...2
V )
2
of the head to the toes noting down all the injuries, with exact
measurements and its size, shape and situations Cyanosis in the
finger lips, oedema of the ankle regions, dried blood stains and
Post Mortem peeling of cuticle if any, to be mentioned in the Post
Mortem report.
The injuries noticed and recorded by the investigating officer
should be verified and if there is any discripancies noted on the
body, the same should be mentioned in the Post Mortem report.
A brief general discription of the body as to the sex, age,
colour of skin, hair, deformities, Injection marks, tattoo marks
to be noted in the Post Mortem report, Neck and head specially should
be
carefully examined for signs of voilence.
Poue down the changes that occured due to lapse of time after
death sucn as, extend of rigornortis, post mortem staining in the
dependent par t and signs of decomposition if any to be noted ddwn<
Note down all the injuries as to the nature, size, shape, edges
of the wound, situation on the body to be described in detail, if
possible with d ia grama tec sketches.
Open the 5 major cavites such as skull, Thorax and Abdomen by
classical incision and examine individual organs in detail for the
presence of disease, injury, blood clots, pus e tc. ,
If it is case of suspected poisoning or no cause of death is
found on autopsy examination preserve viscera for chemical analysis
and tissues for Histopathological examination nhenever necessary.
After the examination the organs to be put back into the body
cavi.
ties neatly stiched, washed and handedover to the relatives
through the concerned Police.
Furnish the Post hortem report immediately after the Post
Portem examination and issue the report to tlie concerned ^olice in
hours
por rules.
C
‘>r-U-Tn,R^AVUK^f._^
o'-/1'’
’•"< □( Forsni/o M.dicm.
Conducting po3/ Mo rtem s
Writing the autor.sv re; xj r t..
/3^
■
The Post-Morte^m examination ±«? a
is important
a
.
J"S a very
oierp
Of evidence in
criminal trials and t-bo v. /
nd
thl3 uort should ado
d the
-'
the utmost
umost cara and MX
formal duty.
aM at,ould not perfora it
a
The post t
findings and is
.. =W.C1.11Y
every finding -r t. ,u.„lon.d
’ - -
of th,
£or „edldo 1<gai pumo
* ln the courp of tau-af
few years.
when
a
The Autopsy report form is a
various section of the examination printed proforma in which the
and organs are Printed,leaving
blanck spaces for the insertion
of the findings,
The external examination of the
body should include length
of the body,
apparent state of Nutrition,
colour of the skin tobe
mentioned in the autopsy report.
estabn
" UnldSntifie^
establish ldentity such as
J
matures
which may help to
eye colour, colour of hair tobe noted down. deformities, dentures.
For estimating the time of death
Hypostasis
■
r,r-»
sirmo
4=
' presence of rigor morti^s
signs of Decomposition should be recorded.
Condition of the pupil size, petichial
-conjunctival haemorra^ if prese^ tQ . " 1 hae—^ges,
injuries discribed in detail as to th°
nOted'
tion on the body . if possii51e wifch sk\Xn^'
sub,
external f
Shape33 situa-
In the Internal examination
record all abnormalities of
Thoracic, Abdominal
ocgan^
Describe any abnormilities in the
heart like Hypertrophy of the
1Sft ventricular wall, thickening
and narrowing Of the
coronary vessels and any pathological defect
in the valves of the
heart and pathology in iarge ve33els.
Examination of the stomach
include contents, smeUz and condition
of the stomach Mucoha
tobe noted down.
examine the brain for
any signs of infection such as pus,
necrosis and different
types of intracranial Hemorrages.
3ase of
the skull to be examined for
any hairline fractures etc.
. . .2
\ /
(1-C
1
2
The
■■3C
V /f-A
Vc
,
•3 tr ip
ve facts must be recorded at
or immediately
after the completion of autopsy.
The report may be hand written
or typed. , when typed, original
copy to be retained.
any alteration should be initialed.
After the detailed discription of the
external and internal
appearances, in conclusion
f?
1. Time of death to be recorded from
appearance of the
postmartum changes in the dead body.
2. Age of the injuries
to be mentioned from its appearance,
<
3. Cause of death to be mentioned. tQ
Qf knowlM_ge based (
on facts of pathology or trauma found on the examination
of the dead body of the deceased.
€
Hoad ot th*
yTof*«*o* &
of Foranslc Madlclne
OoQ3rt»n®,'t
Hosoltal. 8.M.C. a.nailcr*-
C
0
MODEL POST MORTEM
model post mortem report form
(Read carefully the instructions at Appendix 'A’
NAME OF THE INSTITUTION
*
Post Mortem Report No.
Date
Conducted by Dr.
Date & Time of receipt of the body
and Inquest papers for Autopsy
*
Date & Time of commencement of Autopsy
Time of completion of Autopsy
Date a Time of examination of the
at Inquest (as per Inquest Report)
dead by
Name & Address of the person
Videorecording the Autopsy
Note :
CASE PARTICULARS :
1- (a)
Name of deceased and as .antered in the jail or police record.
(b)
S/O, D/O, W/O
(c)
Address
2. Age (Approx) :
)
Yrs:
Sex : Male / Female
3. Body brought by (Name and rank of police officials)
(i)
(ii)
■y
of police station
4. Identified by (Names & Addresses of relatives / persons acquainted)
0) ________
(H)
HOSPITAL DEAD BODIES - (Particulars as per hospital records)
Date & Time of Admission in Hospital
Date & Time of Death in t lospital
Central Registration No. of Hospital
SCHEDULE OF OBSERVATIONS
A) GENERAL
1) Height
,cms
(2)
Kgs.
Weight
* 3) Physique - (a) lean / Medium / obese
b) Well built / average built / poor built / emaciated
4) Identification features (if body is, unidentified)
•)
•0
iii) Finger prints be taken on separate sheet and attached by the doctor.
5) Description of clothes worn - important features.
6) Postmortem Changes :
a) As seen during inquest :
2
/
.vu.u.
mortis present
Temperature (Rectal)
1
Others
J) As seen at Autopsy
) (a)
External general appearance
b)
State of eyes
c)
Natural orifices
')EXTERNAL - INJURIES :
^ntion Type, Shape. Length X Breadth & Depth of r
1 ' •
each
and its relation to important body landmark.
Ucate which injuries are fresh and which are old and
theirinjury
duration.)
^TRUCTIONS :
)
3
Injuries to be given serial numbers and mark similarly on the body diagrams attached, (ii) In slab injuries, Mentii
state of angles, margins, direction inside body, (iii) In fire arm injuries, mention about effects of fire also, (effects
flame)
INTERNAL EXAMINATION
1
HEAD
(a) Scalp findings
(b) Skull (Describe fractures here & show them on body diagram enclosed)
(c) Meninges, meningeal spaces & Cerebral vessels
(Hemorrhage & its locations, abnormal smell etc., be noted)
(d) Brain findings & Wt.
gms)
(Wt.
(e) Orbital, nasal & aural cavities - findings
2 NECK
Mouth, Tongue & Pharynx
Larynx & Vocal Cords :
Condition of neck tissues
Thyroid & other cartilage conditions
Trachea
4
/
ILbl
Ribs and Ghost wall
Oesophagus
Trachea & Bronchial Tree
Pleural Cavities
R
L
Lungs findings & Wt.
Rt.
gms & Lt
'T
Pericardial Sac
Heart findings & Wt.
*
Large blood vessels.
4.
ABDOMEN
Condition of abdominal wall
Peritoneum & Peritoneal cavity
Stomach (Wall condition, contents & smell) (Weight.
Small intestines including appendix
Large intestines &
Mesentric Vessels
Liver including (Wt
gms)
gall bladaer
5
)
gms).
gms
V
Spleen (Wt
.,u>
gms)
Pancreas
Kidneys finding & Wt.
Rt.
5ms & Lt
gms.
Bladder & urethra
Pelvic cavity tissues
Pelvic Bones
Genital organs (Note the condition of vagina, scrotum, presence of
foreign body, presence of fetus, semen or any other fluid, and
contusion, abrasion in and around genital organs).
5 SPINAL COLUMN & SPINAL CORD (Tn bi
e opened where indicated)
OPINION
i)
Probable time since death (keep all factors including observations at inquest).
ii)
Cause & manner of death - The cause of death to the best of my knowledge and belief is
a)
Immediate cause
b)
Due to
c)
Which of the injuries are antemortem / postmortem and duration if antemortem ?
6
)
d)
Manner of causation of injuries
e)
Whether injuries (individually or collectively) are sufficient to cause death in ordinary course of nature or not ?
iii) .Any other
SPECIMENS COLLECTED & HANDED OVER (Please tick)
*
b) Clothes
♦
c)
Photographs (Video cassettes in case of custody deaths), finger prints etc.,)
d)
Foreign body (like bullet, ligature etc.)
e)
Sample of preservative in cases of poisoning
f)
Sample of seal
9) Inquest papers (mention total number & initial them)
h)
Slides from vagina, semen or any other materia!
PM report m original.----------------- inqUeSt papers, dead body, clothings and other articles
(mention there) duly sealed (Nos.) handed over to police official
No.
of PS
Whose signatures are here with
•*
Signature
Name of Medical Officer
(in block letters)
Designation
Seal
7
FULL BODY, MALE - ANTERIOR AND POSTERIOR VIEWS (VENTRAL AND DORSAL)
Name
Case No.
Date :
8
FULL BODY. FEMALE - ANTERIOR AND POSTERIOR VIEWS
1/
1
zq
5
l;
A
I'
I
I
/
/
/
\\
A
Name
------ Case No.
Dale :
9
)
< )
ANATOMY, LATERAL VIEWS
------- J'— '
I
(Yf.f/J J
'•-I
lx
5
vJ
k
CL! JI.Q
I
Name
Case No.
Date :
10
"A
IS
1
)
11
>
)
I
K /
APPENDIX-’A’
INSTRUCTIONS TO BE FOLLOWED CAREFULLY FOR DETECTION OF TORTURE ;
i
(Read carefully the instructions at Appendix'A'
I
PHYSICAL FINDINGS
TORTURE TECHNIQUE
i
ACTING
1.
General
Scars, Bruises, Lacerations, Multiple fractures at
different stages of healing, especially in unusual
locations, which have not been medically treated.
2.
3.
To the soles of the feet, or fractures of
Haemorrhage in the soft tissues of the soles of the
the bones of the feet
feet and ankles. Aseptic necrosis.
With the palms on both ears Simultaneously.
Ruptured or scarred tympanic membranes. Injuries
to external ear.
4.
5.
On the abdomen, while lying on a table with the
Bruises on the abdomen, Back injuries.
upper half of the body unsupported ("operating
table”).
abdominal viscera.
To the head Haematomas.
Cerebral cortical
atrophy,
Ruptured
scars, skull fractures.
Bruises.
Suspension
6.
Bruises or scars about the wrists.
By the Wrists
Joint injuries.
Bruises or scars at the site of binding, prominent
By the arms or neck
lividity in the lower extremities..
8.
By the ankles
Bruises or scars about the ankles. Joint injuries.
•9.
Head down, from a horizontal pole placed under
Bruises
the knees with the wrists bound to the “Jack”.
backs of the knees.
or scars on the anterior forearms and
Marks
on
the wrists and
ankles.
Near suffocation
10.
Faecal
Forced immersion of head is often contaminated
material
or other debris in the mouth,
pharynx, trachea, oesophagus or lungs,
“ Wet submarine".
Intra-thoracic pelechiae.
■ 11.
Tying of a plastic bag over the head (“dry submarine")
Intra-thoracic pelechiae.
Sexual abuse
12.
Sexually transmitted diseases. Pregnancy. Injuries
Sexual abuse
to
breasts, external' genitalia, vagina, anus
rectum.
12
or
\ /
• posture
13.
Prolonged standing
Dependent edema. Petechiae in low exlremili0s.
14. 'Forc€.‘d straddling of a
bar (“saw horse")
Perineal or scrotal haematomus.
Electric Shock
15.
Cattle prod.
BURNS : Appearance depends on the age of the
injury.
Immediately : spots, vesicles, and / or
blackexudaled within a few weeks : circular,
reddish macular scars. Al several months small,
white, reddish or brown spot resembling
telangiectasias.
it
16.
Wires connected to a
17.
Heated metal skewer inserted into the anus.
source of electricity.
Peri-anal or rectal burns.
a
Miscellaneous
18.
Dehydration
Vitreous humor electrolyte abnormalities.
Animal bites (spiders, insects, rats,
Bite marks
mice, dogs.)
1
13
)
V I
8
22) Drugs Acting on the Uterus
23) Infusion Fluids
24) Minerals,Nutritional Additives
5) Anti~didbetics
id^tics.•- nri
oral andj Parenteral
STORE-STOCK maintaining PROCEDURE-
>
The
store.
following
four
registers
should
be
maintained
in
the
1) DAY SOOK:For monitoring the receipt
of any item prior to
entry in to the stock book.
2}-STOCK REGISTER:- Showing the
source of procurement and date
of
on hand.
receipt, issue and balance
3)DATE OF EXPIRY REGISTER
This sould be maintained
t
the drugs due to expire.
MOH for every two months.
compulsarily to keep advance track of
This register should be monitored by
4)ADVERSE REACTION REGISTER:MOH
,
PHC,
should
record any
adverse reaction of
any drug either in OPD 047 in-patient.
This
matter of adverse
reaction should be brought
to the notice of TMO
/DHO’.
bin-card
1
This will help in
knowing on the spot the
position of a particular
drug and the pattern of
Date of expiry of drug ,
source of procurement.
Details on Bin-Card;-
Date of
Expiry of
the
should attest the issue
Action taken
expiry:-
to
drug
should
be written
and balance columns.
dispose
of
the
drugs
in
exact
stock
expenditure.
Red
ink.
MO
?
which
are
nearing
date
The Bin-card is like a
mirror which gives complete information
of
a drug.
Mp 'WO
- SOCHARA' yA
,(J f
O
Ko rani an ga la
J
n
9
PROCEDURE FOR DISPOSAL
t
——NEARING DATE OF EXPIRY DRUGS:Any drug which has got six months time before the date of
expiry
and which is nou being utilised in your institutions
should be informed to TMO
in monthly meetings, so that TMO can
take action to redistribute the drug
to other needy institutions,
This procedure should be adopted
regularly in every monthly
meeting till the drug is shifted
at least 3 months before the
date of expiry so that other institution can make use of
use
or
replacement can be made.
BUDGET ALLOCATION:Know your institutions budget allocation
ear marked for drugs from G.M.S. and from
should be clearly understood.
The total amount
District
Sub-Store
see ANNEXURE NO. I.)
CIRCULATION OF AVAILABLE DRUGS IN THE INSTITUTIONS : The list of Drugs available in the institution should
,c_irculated among the other Doctors of the Institutions
effective health care delivery system.
be
for
STATEMENT SHOWING THE VITAL ESSENTIAL AND DESIRA.BLE
AND LIFE
SAVING DRUGS IS AS FOLLOWS.
(Please see ANNEXURE NO.II)
Before concluding it is suggested to have an emergency drug
kit which should contain the following :
1) Injection Adrenaline
t
2)
Injection Hydro cortisone/Betamethasone/Dexamethasone
3) Injection Deriphylline/Amino Phylline.
4) Injection Diazepam.
5) Injection C.P.M.
6) Injection Dichlofenac
7) Injection Fortwin
S) I. V. Dextrose 5% /DNS /Linger Lactate.
9) Injection Ranitidine
10) Injection Botropase
15)Injection baralgan
11) Injection Atropine.
12) I.V.Manitol
16) Injection Metachlorpropamide
+
13) Injection P.A.M.
Scap-vein set. .
14) Injection ASV
I.V.Cannula
+
I.V.Drip
I.V.Drip
set +
ANNEXURE NO. I.
BUDGET ALLOTMENT FOR DRUGS AND CHEMICALS
100%
40%
60%
4
Rs
1) PHU’s
30,000-00(GMS)
2) PHC's
50,000-00
3) G.H or C.H.C's 3,00,000-00
4) C.H.C's &
2,00,000-00
Rs
Rs
20,000-00
30,000-00
1,20,000-00
1,80,000-00
80,000-00
1,20,000-00
Tq.level PHC
5) SUB-CENTRES
5,000-00
each .
) SET CENTRES
Each
4,000-00
7) Dental Package
Each
10,000-00
!) NLCC
75,000-00
30,000-00
45,000-00
30,000-00
12,000-00
18,000-00
i) MLCU
P.T.O.
t
\ I
cne drugs have to be listed with the
help of Store Pharmacist
from the Stock registers. All the drugs to be
arranged in a descending
order of their Annual Consumption Value,
On tha basis of total cost
drugs are to be classified into A3C
categories.
TABLE 1. ABC Analysis of the
Drugs during 1995-96
I terns
Category
Annual Consumption
Total number
%of all items
value" in Rs.
% of total
Consumption
A
B
C
86
125
331
16
23
61
5137533.88
1467866.86
733933.40
70
20
10
Total
542
100
7339334.14
100
But However VED Analysis is better than
ABC Analysis.
E = Essential , D = Desirable.
Here you can
Hospital.
see the top ten items
TABLE 2.
Items
1
of
a particular
The Description of Top ten items.
Name of the item
3
expenditure
V = Vital,
Tab Erythromycin 250 mg
Cap ampicillin 250 mg
Percentage of
Total budget
10.7
Tab cotrimoxazole Plain
4
6
Tab Baralgan
6.8
Cap Tetracyclines
Tab Nidazest 5 mg
(Ethynyl Oestradiol)
13
Dextrose 5%
6.8
Cap amclox
Tab desferol
Cap Raricap
Total
24.3
TABLE NO.3. VED Analysis
Category of Drugs
V: Vital
E: Essential
D: Desirable
Explain About Lead Time
No. of Drugs
116
172
254
Internal & External
.'.'.AiOA ZLr.
"
■
\
’S of total Drugs
21
32
47
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I
RESPONSIBILITY Of MtAWIIW ABTD DIBBORSIHG OmCKKS
•* . •
. r
3 • ■ •/
K. MR.UTHYUHJAYASWAMY
Faculty (Financial Management)
A.T.I., Mysore.
r
and
S. SIDDARAJE GOWDA,
Joint Controller (Retd),
State Accounts Department,
Mysore.
)
Dutte/a towftrdfl Account, a: -
Every Government Servant shall ensure that proper
accounts are maintained for all government financial
transactions.
He should render accurate and proper
accounts to the A.G. He must be thoroughly conversant
with all the Finance Rules. He should conduct frequent
checks to ensure that his subordinates will not commit
any fraud, misappropriation or irregularities.
He
should not rely on his subordinates and should not plead
that he was misled by his subordinates (Art. 3 of KFC).
•>
1.
Amount realised on behalf of government should be
paid into government trea-rury within 2 days since
amounts <collected should not be kept away from the
treasury balance (Art, 4 & 7).
2.
Separate
accounts
should
be
maintained
government money and non-government money (Art.
3.
Government dues paid in the form of cash, cheque,
bank drafts , ]postal orders and money orders should
be accepted (Art.
- 4).
>
i
1
for
4) .
4.
Cheques and drafts .'should be treated as cash and
entered in cash book,, like other cash transactions.
5.
A government officer receiving money on behalf of
government must give the payer a receipt in KFC form
No. 1. (Art. 6).
6.
Heads of offices should keep a complete account of
the receipt books that they have received (Art. 6) .
7 ,
The money received should be brought to the cash
the receipt number being noted
book immediately,
therein (Art. 6) .
8.
Any person paying money into government treasury^
will present with it challan in duplicate in KFC
Form No. 2.
When money is paid by a private party
into a treasury, the copies of the challan should be
initialled by the departmental officer (Art. 8) .
9.
At places whei^e the cash business of the treasuries
is conducted by the bank, cheques on local banks may
be accepted.
When cheque is received,
only
a
preliminary acknowledgement be issued and final
receipt be issued after the cheque is cleared (Art.
9) .
10.
The stamps affixed to documents should promptly be
punched.
Otherwise it gives scope for fraud and
loss of revenue.
11 .
The drawing and disbursing officers are required to
write their cash books independently end not on the
basis of treasury schedule and send their monthly
accounts/returns to the controlling officers after
duly reconciling the departmental figures with that
of treasury and furnishing a certificate to that
effect.
Every departmental controlling officer
should obtain regular accounts and return from hie
subordinates for the amounts realised by them and
paid into the treasury and consolidate the figures
for all the departments.
They should closely watch
the progress of the realisations of the revenues
under his control and check the recoveries made
against the demands.
o
< /
The controlling authority have to reconcile the
accounts with A.G.
The DDO's should take prompt
action to recover the moneys due to government. The
following dates for issue and receipt of the above
return are prescribed for adoption.
I
e>
Date of despatch from the
AG's Office.
20th of 2nd month
following.
Date of return by the
department after
verification.
10th of 3rd month
following
Regarding the yearly
accounts ending on March.
Not later than the
end of June
send
The
controlling
authority
should
for every
certificate of reconciliation to A.G.
month before the 15th of the 3rd following month.
This certificate should also be recorded in the pay
the
to
bill
for
each
month,
pertaining
reconciliation of 3rd previous month (Art. 32) .
9,
12.
occupying
servants
Rents
due from government
government buildings should be recovered regularly
by deduction from the salary or establishment bills
of such government servant as per the rates and
charges intirna.ted by Executive Engineer (Art. 41).
13.
If a claim be relinquished the value of the claim
shall not be recorded on the expenditure side as a
specific loss.
Remissions and abandonment of claims
to revenue shall be reported to the A.G. in the form
of an annual statement with reasons before the 1st
June of the next financial year (44-A of KFC). .
14 .
Public
money
in the
custody
of
government
departrrents shall be kept in strong treasure chests
and secured by 2 locks of different patterns.
All
the keys of one lock should be in the custody of the
gazetted government servant who is in charge of
cash.
All the keys of the other lock should be in
the possession of the cashier. This disposition of
the keys is for the definite purpose
of ensuring
that the chest should never be opened or closed
without both the custodians being present.
present.
When
there
are no double locking arrangements for the
3
cash chests the cash should Invariably be lodged in
the inside drawers, the keys of which should be with
the gazetted government servant in charge of cash
and the outer keys of the chest with the cashier.
When the government servant in charge of cash is on
tour or on leave, he should handover the keys of the
chest together with the contents to any other
responsible government servant. The duplicate keys
of cash chests of government offices should be
deposited in sealed packets in the
Government
Treasuries with which the offices transact (Art. 12,
13) .
15.
Every office should maintain “Register to watch the
the
movement of Cash/Bills/Cheques*’ and obtain
signature of concerned officials (Art. 345 of KFC).
In essence, every expenditure should be relevant to
the objectives of the organisation and it should not be
more than the occasion demands.
1. To incur any item of expenditure, there should be
The
competent sanction and budget allotment.
government servant must satisfy the cannons of
financial propriety.
(i)
Every government servant should exercise the same
vigilance in respect of government expenditure as
a man of ordinary prudence would exercise in
respect of his own money;
(11)
Ho authority competent to sanction % expenditu-re
shall pass an order which will be to his own
advantage directly or indirectly;
(ill)
The expenditure should not be in favour
particular person or section of community;
of
a
(iv)
Expenditure such as T.A., etc., should not
source of profit to the recepient;
be
a
4
J
(V)
The
sanctioning authority should
not
incur
expenditure which at a later date may proved to be
beyond his power of sanction; and
(vi)
Best possible results should be obtained from
public funds, keeping in view both economy and
efficiency (Art. 15 and 16 of KFC).
2,
Delays in payment are opposed to all rules and are
highly inconvenient and objectionable.
The Heads of
Offices should clearly understand that the personal
claims of government servants should be discharged
with the leant possible delay.
In any case claims
should be settled within one year from the date when
it becomes due.
If it has to be paid after one
year, condonation of delay is necessary (Art. 20).
3.
Before, condoning the delay regarding the arrears of
payment, the Head of Department should exercise the
following checks.
5
la
>
t
(a)
Claims should be
Accounts Officer.
(b)
Verification
records.
(c)
The claim should be established beyond doubt.
(d)
It should not result in wrong or double payment.
(e)
Suitable register to be maintained to watch such
sanctions (Art. 20).
got
should *
scrutinised
be
done
with
by
Chief
original
4,
Regarding payment of arrear claims, to avoid double
claims/payments the drawing officer shall make a
note of the payment, in acquittance rolls,
service
registers, office copies of original bills, etc.,.
5.
In the case of payments made out of permanent
advances, the amount should be recouped at once and
in other cases, the liability discharged at the
earliest possible time.
Claims preferred within one
year (even though they related to previous year) can
be settled by the Head of the Office, without higher
5
for
Contingent bills not preferred
sanction.
be
recoupment within 3 years should, as a rule not
sanctioned or ]permitted to be encashed (Art. 21).
The right of a government servant to travelling
(tour T.A., transfer T.A. and conveyance
allowance
claims)
including daily allowance
allowance,,
is
allowance
_■
•
•
;
been
relinguished
if
the
forfeited or de-sroed to have
claim for it is not preferred to the head of the
the
office or the controlling officer or the A.G. aswhich
from
the
date
on
case may be, within one year
it becomes due (Art. 22-A).
6.
7.
8.
concerned
The LTC/HTC
LTC/HTC bills
bills should be submitted by
government servants within one month, from the date
on which it becomes due (Art. 22-A).
'7 authorise a gazetted
The Head, of- an Office may
bills.
government servant serving
i-- --- under him to sign
’
*
.
But
the
head
vouchers, and payment orders,for
(Art.
responsible
of the office continue to be
L- held
—
24) .
9. The head of the office shall ensure that the payment
and he should obtain
is made to actual payee only
c..
clear acknowledgement (Art. 24) .
for
servant supplied with funds
government
C
—
______
fOr
such
funds
shall be responsible
expenditureaccoun7of
“the7ha= been rendered] to the
until an ;
satisfaction of the audit office^ In cases in which
the acquittances of the actual payees are not s®nb
the government servant supplied with
for audit,
be held personally responsible for
funds shall
made to the person
seeing that the payments are
He
shall
obtain for every
entitled to receive them,
behalf'of
government
disbursement which he makes on
which
have been
including every repayment of moneys
a
vodcher
setting
deposited with the government
of
the
claim,
using
forth full and clear particulars
as far as possible"the
possible the particular form if any.
the
prescribed for the purpose and shalx obtain at
a
P-zment
either
=„
the
voucher
or
on
■oFm^ing payment
on
a
paper
to
be attached
to
it.
an
Separate
psPer
pay®ent sisned hr the payee by
acknowlederoent of
or the
tne payment
pay
p- 500 or
Rs.
For the arooun e
hand and ink.
should be
should b
exceeding Rs. 500 stamped acknowledgement =hould
obtained.
In exceptional cases,
1=^°, nee?
cases
to obtain
proper
vouchers,
the
officer
r
disbursing
obtain proper vouchers, -jftificate
saying
that
charges
may record the <----
10. A
6
1
reasonable and actually paid.
When an article is
paid,
obtained by
VPP
the
value
payable
cover shall be
by
Pay
order
should
be recorded on
treated as voucher,
by
attestation
words
and
figures
with
voucher in
payment
order
,
disbursing officer. Without this
should not be effected (Art. 49, 50).
)
11. The Head of the Office is personally responsible for
all moneys drawn as pay, leave salary, allowance,
etc., in an establishment bill signed by him or on
his behalf until he has paid them to the person who
are entitled to receive them and has obtained their
where
2^1
‘ >,
duly
stamped
dated
acknO'Wledgeroents
i as
These
acknowledgements
shall
be
taken
necessary,
Separate
bill.
a rule on the office copy of the
acquittances may be maintained for staff and for
The copies of the bills sent to
private persons.
treasury to be maintained in the form of register
(Art. 52).
12 .
Undisbursed amount may be retained in office for a
A register to be
period not exceeding 3 months.
the
10 to watch
in KFC Form No.
maintained
undisbursed amounts (Art. 52) .
13 .
Sub-vouchers to contingent bills should be cancelled
in such a manner that they cannot subsequently be
-used fraudulently to claim or support a further
payment (Art. 58).
14.
servant should
give
proper
Every
government
all^objections
and
orders
received
from
attention to
• ■ * ’ n
the A.G. without any avoidable
delay.
A register
shall be maintained in each office in KFC Form No.
11 for recording the objections communicated by the
Audit Office (Art. 60).
15.
Every government servant who draw bills for pay and
primarily
allowances on contingent expenses is
responsible for the correctness of the amount for
If any amount is drawn in
which each bill is drawn,
excess of what is due, the drawing officerwill be
required to make good the excess amount is drawn
(Art. 62).
16 .
Each head of an office will maintain a register in
KFC Form No. 12 for all special advances drawn by
him.
It is the duty cf every government servant to
prompt adjustment of advances and items
see to the
'
I
7
under objection outstanding ^^t him in t
b k
of the audit office.
If. owing to delayii" us table
with the matter, any amounts become unadju
they
will be recovered prorata from all
sovernmeat 5ervant= durins ul-.one time, th./ renamed
under objection (Art. 63).
17. The requisitionis of the audit department for supply
of information necessary for purposes of audit
should be complied with by all departments promptly
(Art. 65).
officers
j by
disbursing
by
books required
18. Cheque
treasuries like PHD & Forest
authorised to draw on
•_a obtained by them from
etc., should be
Departments ,
requisition signed by the
a --the treasury■ officer on
himself.
Cheque book must, be
disbursing officer
lock and key in the personal custody■ of
kept under
charge
officer and when transfer
the drawing a note should be recorded in the cash
,
takes placethe
and
signature of both the relieve
over
book,
unused
number or
the relieving officers showing the
-22*
over and received in
cheques and cheque books made shall
be issued for a
No cheque l.
transfer bv them.
cheque
at right
On the
sum less than Rs. 10.
"under"
followed
by
angles,
the word to be written the amount written on
an amount a little larger than on banks for amounts
t------cheque.
All cheques/drafts
,
other
than
payment
exceeding Rs. 1,000 in each case etc.,, of government
premium,
of salary, iallowances,
—
with the
should
invariably be crossed,
servants
If
_____ Payee
Payee Only" •
addition of the words “Account
the
handing it over to
cheque drawn
drawn is
is lost,
lost, before
'and'stop order to
u-payroent certificate
party, the nonnon-payment
ce v
-treasury
Afterwards
be obtained from bank/and or treasury reque3t for
fresh cheque may be drawn.
drawn^
c£eciue given to
the
fresh cheque on
pretext
_-rtificate and stop
treasury.
from bank and
an cheque may bond
Further, the party ha= to rexecute
^ds fresh
be
in KFC Form ho. 73. Alterwaru^
drawn (Art. 66, 72)
— “n account with a
may open
an
19 . Mo government servants
the"deposit
of moneys
by him in his
private bank for ’-- - official capacity (Art. 76) .
20.
, for the continuance of temporary posts
r?hsre actionperiod u.?to which may stand sanctioned
beyond thetaken
]
but the competent authori y^ _j not
has been sanction, the holders of such temporary
--accorded
3
f /ff
)
posts may draw provisionally, without any authority
from the A.G. their pay and allowances at the same
rate as they were drawing in that post for a period
of 3 months after the expiry of the period upto
which the posts had been sanctioned (Art. 80(A).)
other
21. Pay,
leave salary and
officiating pay,
emoluments can b'a drawn for the day of a government
servant's death, the hour at which death takes place
In case of death
of
does not affect claim.
government servant, the office head can make payment
to the claimant upto Rs. 5,000 without insisting for
5,000, office
legal authority.
If it exceeds Rs.
head has to obtain an indemnity bond in KFC Form No.
13 duly stamped with sureties and also he has to
obtain the orders of Head of Department.
In case of
death of gazetted officers necessary authorisation
should be obtained from A.G. (Art. 81).
22. Office heads are responsible for the deduction
income tax at the prescribed rates in respect
non-gazetted staff (Art. 89).
of
of
23. It is the duty of the office head receiving the
court attachment order, to see that the amount
attached is deducted from the pay bill and also that
a record is kept of such deduction in KFC.Form No.
78. Office heads should not enter into any kind of
correspondence with the court and they should not
forward the representation of government servants
(Art. 90 to 93).
(a) . Recoveries are to be effected out of the salary
payable and sent to Court or Society as the
case may be;
(b). In respect of Court attachment, it has to
shown as a deduction in the Pay Bill,
respect of Society dues it may be disbursed
cash;
be
In
in
into
enter
not
should
(c) . The
Officer
forward
with the Court or
correspondence
He has to simply execute
representations.
provided the money is available;
)
9
(d). If the Government Servant does not sign or
allows it to be undisbursed, in such cases the
Head of the Office in case of Non-Gazetted
Officers and the Head of the Department in
respect of Gazetted Officers, may■ draw the pay
and pay the warrant amount;
(e) . The following are the limits for attachment
J?c.y •
of
(i) Salary to the extent of first four hundred
rupees and two-thirds of the remainder is
the
not liable for attachment towards
execution of pay decree, other than a
decree for maintenance.
Allowances,
of
Travelling
kinds
Allowances,
Uniform
and Ration
Conveyance
Allowances,
House
Rent
Allowances»
Allowances
and
Reimbursement of Medical
provide
relief
granted to
Allowances
are
cost of living
against increased
exempted from attachment.
(ii) All
house rent,
24 . Ou t of subsistence allowance, taxes,
If
deductions
.
loans and advances are compulsory
requests
,
government servant who under suspension, societies,
insurance premium, dues of cooperative
The GPF
recovery of GPF advance may be deducted.recovery of
court attachments and
subscriptions,
The rate*of recovery out
loss should not be made. should not exceed one-third
of subsistence allowance
of the gross subsistence allowance (Art. 94-A).
does
25. In case where an officer_• deputed for training over
'
duties
and th>s handing
not disch-Cirge statutory
u
of cash or stores is not involved and the total
absence from headquarters does not exceed W days ,
the handing over and taking over charge of the post
is not required.
of a gazetted government
26 . Every transfer of charge leave
or on transfer or
servant proceeding on
be
returning
from leave should, without fail
in
Form
the A.G.
reported by post ont the same day towho
is responsible
Every
government
servant
•So . 19 . L .
advances
and
who
is
adjustment of
for
the
office
before
•
fully
to
ano th e r
transferred
him
for
the
amounts outstanding against
accounting
10
s
3
5
should leave for the information and guidance of his
state
successor, a memorandum clearly explaining the
•‘ ; Jy
the
of
each
item
of
advance
and
noting
—
accounts
Of
outstanding
the
<
--tobe
taken
for
adjusting
action
■ xii the time allowed by the sanctioning
amount.'J within
If
he does not do so, his responsibility
autho.vity.
will not cease and his successor may not be held
the items not brought to
responsible in respect of
>
the latter's notice.
A statement of unadjusted
advances and unremedied objections should be given
bv the relieved to the relieving government servant
in KFC Form No. 20 & 21 respectively (Art. 100) .
27 . The entire salary■ for the month in which a
been i---- -
3
9*
>
transfer
dtre“n^ne^:„tM«rv^t
transferred, after the close of the month, attaching
these to the requisite LPC and not in several bills.
In respect of government servants transferred to
local
funds
the Joining time'
allowance
and
-travelling allowance for the forward and
journey shall be borne by local body concerned (Arr.
129) .
on a separate
28 . Arrear pay shall be drawn on
not in the original monthly pay bill
The non
drawal certificate on the previous occaaion shallb
recorded.
Only one bill is sufficient for all
Only
arrear claims
claims of different months which are drawn at
the same
time, particular ox ciaiua of different
..ne same
same time,, particul*
shows separately in the
being
however, claims should be noted in
bill 3’ All
isupplemental
All supplemental
billp
... -- - rolls. This is necessary to
the original acauitt.ance
risk"oi
’
*ciaiming
again. A 'Due and Drawn
UllC
in
respect
of
arrears of pay
and
Statement'
u
government
servant
’
shall
be
prepared
allowances of a
by the <drawing
------ and disbursing officers (Art. 132).
29.•Travelling allowance of establishment other than
permanent or fixed allowances , shall be drawn in KFC
of
the
Form No.
29 settingforth the details
or
divergence from
from the
journeys and explaining any divergence
recognised route; ordinarily not more than one bill
will have to be preferred for the claims of a
particular month in respect of a government
travelling
government
servant countersigning
servant
The
allowance bills will maintain a register in KFC Form
note the bills
he
ho.
30
0 in which ho will
137)
.
co’.:?.torsi gns (Art.
is
and also to prepare an account in
(Art. 346).
Form
KFC
62-E
33. A proper record of personal advances drawn and
repaid by non-gazetted government servants should be
kept in all offices in a register in the form
mentioned
under Article 347 of KFC.
A separate
register for each kind of advance is not necessary
but a separate sheet may be allotted in the register
(Art.
for each individual who has drawn any advance
347) .
34. The head of office is responsible for any loss
sustained by government through fraud or negligence.
He has to take all precautionary steps regarding the
etc.,
by
movement of cash/bills/cheques/stores ,
from
government
obtaining
adequate
security
Particularly
he
ser.vants/contractors/supplier.
should be cautious regarding the genuineness of bank
guarantees, its
period
vis-a-vis
with
the
fulfillmentof terms
and conditions by suppliers
and/or contractors.
He has to follow the procedure
laid down in the Articles from 353 to 359 of KFC.
As per Article 332, deficiency found in cash,
person
should
the
be made
made good at once by
the
when
As per Article 338
responsible for it.
government servant in charge of cash goes on tour or
on leave should handover the keys of cash chest with
government
contents
to any other
responsible
servant.
If loss takes place, the head of office should
send preliminary report to HOD, A-G.,* Secretary,
F.D. ,
through proper channel, explaining the nature
and
circumstances with extracts of
documents .
Subsequently, the office head shall conduct detailed
investigation and send final report to A.G., H.O.D.,
and Secretary through proper channel. The detailed
report should contain the nature of loss
loss,,
amount
involved, persons responsible, citation of documents
and its extracts, modus operand!, recoveries made,
or
action/judicial
action
taken
disciplinary
defects in system,
steps taken to
recommended,
prevention.
35. In
all offices, a register of valuabale documents
te maintained and the receipts and disposal
herein under the initials of a responsible
should
be
servant.
The documents
shoiiKi
preserved in safe or other receptacles intended
to
keeP
valuables coming into possession
of
the
government servants concerned (Art. 367).
>
To conclude it is the duty of every
Government
Servant to observe complete
in financial
matters and censure that best integrity
results are
from the public funds
obtained
_ ---- j spent by him and
strictly
Euard against any kind of wasteful
expenditure.
He
should not only satisfy himself but
also satisfy the
■requirements of audit.
3
drdlofre.kms
I
15
PggVENTipN ATjD DETECTION OF FTOUD IN
FJI AL MANCW^NT JN
K.rWTHYIJNJAYA SWAW
Faculty
ATI, Mysore
3
/
3
Article
disbursing
over
3 o-F KFC, mentions that. the
drawing
officer <DDO> should keep an adequate
subordinates
irregularity.
He
in
order
to
avoid
cannot plead that he
and
check
financial
was
misled
or
Prevention is better than cure. Despite taking
lot
deceived by his subordinates.
of
precautions,
also
.to
fraud might takes place.
Such
frauds
be detected' in shorter time and action
to
be
taken on the concerned official's and also action
to
be
taken
to prevent it. Therefore DDO has to be
extremely
cautious.
)
Negligence
ignorance
or
incorrect
hand1ing
of
procedures^
of financial implications of decisions
or
will
give scope for fraud or it may result in any kind of and
financial
area
irregularity.
Fraud may takes place
in
any
of financial management. It may be in the area
of
receipts, expenditure, deposits and advances.
1
etc. ,
The
cash
in-F lows
various
■Forms.
The
properly
update
assessment list, rise
to Government
takes
place
in
is
to
the
demand
in
the amount in time and to see
that
the
amount is actually remitted to the
government. For
this
time.
he
collect
has
records.
to maintain DCB register
and
DDO's
other
connected
The amount will be collected in the o-F-Fice
the parties, will be asked to remit
to
o-F
responsibility
the arnount
or
directly
Bank/Treasury and to produce the copy of chailan
to
office.
When cash is received in the office.
the
cash
receipt
Has to be issued in the K.F.C. form No.1.
This
cash re>cetpt books will be supplied
by Government
press
to heads of departments
will
and in turn Heads of Departments
supply these receipt
books to subordinate
DDQ's.
At all the 3 points, the stock register of
receipt books
wil 1
the
be maintained. DDO and cashier will
have
to
sign
cash receipts and DDo cannot delegate the
power
of
signing the cash receipt to the subordinates. First
the
cashier
sign
should sign the cash receipt and then D'Da
the cash receipt. The receipt number of
receipt
has
to
be entered in
the
cash
the
book.
will
cash
Whi le
signing the cash book DDO must
ensure all these aspects.
2
>
■
CASE
r
After
ODO has signed cash receipt -For
Rs.4,000-00
without an immediate entry in the cash bock, the cashier
tampered
>
cash receipt by altering
the
Rs. 4,000-00
as
Rs.400—00 both in words and figuries. He has also made an
entry in the cash book for Rs.400-00 only.
The
3
DDO
resulted
the
the
cash
book
blindly,
in embezzlement of Rs.3600-00. This
notice
cashier
signed
in
audit after a lapse
of
2
which
comes
years.
The
has remitted only Rs.400-00 into Bank. Even
>
the
remittance book, the power of signing
remittance
book
was
blindly signed
chailan
by
to
on
and
DDO,
without
locking into the tampered cash receipt. Had he
fol lowed
the procedure, no fraud could have taken place.
Negligence on the part of the DDO's, may end up
much
more
serious fraud. We, even
where
the
duplicate
Pointed
DDO's.
come
cash receipt book
across
cases
has
got
and that duplicate cash receipts are signed
Therefore
DDO should be very alert
such kind of fraud.
)
3
in
to
by
prevent
A -Few cases are ex'lly cited here.
to
It is not possible
predict that -Fraud will takes place in a
particular
way. Some times there will be no solutions or guidelines
in the rules to prevent -Fraud. The alertness o-F mind and
Studying
o-F
accountants
auditors
reports
and
discussion
auditors will be very use-Ful
and
with
•For
the
DDO's.
In cases, where, DD s or cheques are received, only
the
acknowledgement has to be issued and not
the
cash
it
is
mentioned that, cash receipt may also be issued -For
the
receipt.
When
in
the
Departmental
manual,
receipt
o-F
issued.
But the entry to be made in the
cheque/DD,
then the cash
may
receipt
cash
be
receipt,
"This is subject to real isation”. The o-F-Fices with small
transactions
an entry can be made straight in the
cash
book
with the number o-F DD/Cheque. The
huge
transactions,, should maintain the day book in
•Form
o-F
encashment
Care
adjusted".
only, entries to be made in the
should
cheques
received and
"Cheques
o-F-Fices
be taken by DDO's -For
within
entries/total
the due date and
the
correct
having
the
A-Fter
casf}
the
book.
engashment
o-F
trans-Fer
o-F
o-F each page/date wise -From day
book
to
cash
book . Even when there is large cash
transactions,
the
totals
day
will
be
to the cash book. Care should be
taken
by
eri-Fication
o-F
trans-Ferred
the
o-F
the
day book
■For
each
DDO's to check pagewise totals and
carry -Forwarding o-F balances,
day book, to cash book.
4
-Frcm page to page and -From
' CASS
r
the cash day book (receipts), page 6 shows
In
closing
the1
particular
ba 1 ance o-F Rs. 10,000-00 on a
Opening
Balance
on next page
(Page-7)
the
date,
shown
as
particular
day
Rs.1,900-00.
r
The
page
6 and 7 entries are tor
ooJy. The total tor page 6 and page 7 shoKt on page 7 as
Rs.20,100-00,
with a short accounting
ot
Rs. 9,000-00.
This Rs.9.000—00 entered in the cash book. Both the
%
day
book and the cash book a-e neatly signed by DOO. This is
a clear case ot tailure ot supervision .
>
When
that,
r
cheques/DD's are received, DDO's
should
see
it is encashed within’the due date ot payment
to
Government. They should also make it clear that, in case
ot
encashment
payment,
they
departmental
ot cheques/DD’s atter the
due
date
ot
penal ties
as
per
the
are
liable tor
manuals. As tar as possible, ' they
should
accept the local cheque and CD's payable on local banks.
It
this is not possible, DDO's should ask the party
rerni t
produce
the amount directly to the Bank/treasury
the copy of chai lan. Even on copy
of
and
to
to
chai lan,
)
shculd not be acted upon by issuing licences etc., until
it
7
is ascertained that the amount is actually
to the treasury.
5
remitted
When accepting currency notes from the party,
should
be taken, by not accepting fake notes.
notes
are
police
and
received, complaint should
the
matter should to be
be
care
If
fake
lodged
with
to
the
bank/treasury
for
reported
controlling authority.
When
large
amount is sent
to
remittance, sufficient precautionary steps should taken,
It
should
person.
be entrusted to
experienced
Adequate security should be
and
reliable
ensured.
Wherever
necessary police help may be sought.
It is the responsibility of DOO to see that
amount
is actually credited to government account. TJ^is can
ensured — by...., pr ope r, jnon tb I .y_ rec one i 1 i a t i on
with
treasury.
consolidated
The
officer
Treasury
treasury
of
will
receipt and DOO to
be
accounts
send
the
compare
the
accounts
with this schedule.
appeared
in
receipt
accounts,
should
verify
in
detai 1
and lodge complaint with police and
inform
the
control 1ing
his
If the
books and not
The
accounts
in
tre’asury
appeared
immediately, . he
authori ty.
receipts
Departments
wi th
smal 1
receipts transaction, can depute a clerk to treasury for
reconci 1iation
work .
The
person
reconciliation
work
should
not
for
employed
be
the
same
person , empToyed —f.or^rreconoil-i at ion-- work— should—not-
■be
thecsame-person, who has taken the amount for remittance
to bank or treasury.
6
^7
r
• This
case
Hospitals,
they
pertains to 1972. Earlier
used to collect 25
Ps.
in
District
per
patient.
Twice
in
a month, they used to remit
bank .
The
medical superintendent of Hospital
this
amount
to
used
to
>
send the peon to remit the amount to bank with a chai lan
and
>
remittance book. The investigation proved that,
he
used to tear the chailan and put duplicate bank seal
on
the
No
remittance
reconci 1 iation
book
and
pocket
cash.
the
work was done for the period from
76.
The
such
cases detection of fraud is possible only
embezzled amount was around Rs.4.5
1972-
lakhs.
In
through
^monthly reconciliation, which the medical superintendent
had not done.
Only
a
area
of
to
say
is
the
responsibility of the DOO regarding movement
of
receipts
management.
specifically
direct
cash
few cases are illustrated in the
from
how
fraud
It
is
not
possible
wil 1 take^i place.
the point of its realisation to
It
its
ac tua1
remittance to bank/treasury.
New we will look into precaution to be taken in the
area
of expenditure management i.e., cash
prevention and detection of fraud.
7
outflow
and
Funds
wi tlxJrau*a 1
cheques.
Funds
contingenci es,
takes place
will
through
I
bills
and
be
wi thdrawn
-For
works,
estab1ishment
expenses
like
salaries,
:-y »■
l-f-
govemment money, -Following are essential rules have
to
be -Followed.
1. &-idge t allo t/nen t
2. Competent sanction
3. Financial Propriety
4- Purchase rules
5. Accounting
Finally this will be -Followed by Audit.
CgTAgL1BILLS
The
DOO
should
be
cautious
against
payments
regarding arrears i. e. , possibility o-F double
payments,
drawal o-F the leave
encashment twice in a singLe.
ncn-Feeding o-F retirement
on
-Forged
bills against the ODO
egarding entries when
tampering
accounts
date to the computers,
the
in
account,
compared to entries in cash book,
service book, evading
the
advances,
wrong
undisbursed
amount etc., This list is
pay—Fixations,
S
drawal
discrepancy
acquittance rol1, non—en tries
&jt the n egligenCe
blocky
o-F
leave
adjustment
embezzling
not
o-F
the
exhaustive.
result any kind -Frauds.
This
case
Hospitals,
they
Twice
in
a month, they used to remit
bank.
The
medical superintendent of Hospital
in
District
Per
patient.
pertains to 1972. Earlier
used to collect 25
Ps.
this
amount
to
used
to
S€?nd the peon to remit the amount to bank with a chai lam
and
remittance book. The investigation proved that,
he
used to tear the chai lan and put duplicate bank seal
on
the
remittance
reconciliation
book
and
pocket
the
cash.
work was done for the period from
76.
The
such
cases detection of fraud is possible only
embezzled amount was around Rs.4.5
No
1972-
lakhs.
In
through
J
monthly reconciliation, which the medical superintpQdjgn.t
tvid not done.
)
Only
a
area
of
to
say
is
the
responsibility of the DDO regarding movement
of
receipts
management.
specifically
direct
cash
few cases are illustrated in the
from
how
fraud
is
It
not
possible
will take^i place.
the point of its realisation to
It
its
actual
look into precaution to be taken
in the
remittance to bank/treasury.
Now we will
area
)
j
of expenditure management i.e., cash
prevention and detection of fraud.
7
outflow
and
Funds
cheques.
wi tlxjrawal
Funds
contingencies,
takes place
will
be
through
wi thdrav^n
estab1ishment
expenses
I
bills
and
for
works,
1 ike
salaries,
i-
M—
government money, -following are essential rules have
to
be -followed.
1. Gadget allotment
2. Competent sanction
3. Financial Propriety
4. Purchase rules
5. Accounting
Finally this will be -Followed by Audit.
ESTABLISt-TENT BILLS
The
ODO
should
be
cautious
ag a i n s t
payments
regarding arrears i. e., possibility of double
payments,
drawal of the leave encashment twice in a sinoln
non -Feeding of retirement date
on
-Forged
to the computers,
bills against the 000
account,
hlrx~k f_
drawal
discrepancy
regarding entries when compared to entries in cash book,
tampering
the
accounts
in
acquittance roll, ncn-entries
service book, evading
the
advances,
wrong
undisbursed
amourit etc., This list is
pay-fixations,
leave
adjustment
embezzling
not
o-F
the
exhaustive.
But the negligence may result any kind -Frauds.
S
of
I
I
I
Some of the pre—cautionary steps to be taken are as
-Fol lows.
1.
Thorough verification of arrears with
reference
to
excess
or
I
I
I
I
rolls
acquittance
and cash book, to
avoid
3
double payment.
entries
2. When signing the leave encashment bills, the
3
to be made in the service register.
3.
Awareness
of
the
retirement
date
of
the
sub—
ordinates.
to detect the
fraudulent
of establishment bills and other
contingent
4.Re-conciliation of accounts,
encashment
3
bills.
5.
When signing the cash book every entry in
the
cash
book, l^as to be verified with acquittance.
6.
)
On every page, total in the acquittance roll
recorded
in
words with disbursement
to
certificate.
be
For
undisbursed amount, separate register to be maintained.
7.
As and when the leave is sanctioned an entry
made in the service book with attestation.
to
be
I
maintained
by
page number ■for each kind of
advance
name
□n
transfer
or
in
by
progressive
number
alloting
a
clear
retirement
be
and register to
watching
for
wise
I
in installments to be given
g. The recovery ot advances
recovery.
it's
are to be noted
entries
LPC
consulting this register
done
in
accordance
with
may
seek
rules. In case o-f doubts, the DDO’s
relevant
the
be
should
Pay-fixation
9.
opinion
the
of
Accounts
Treasury
and
Officers
officers.
CONTINGENT BILLS
The sub vouchers attached to the bills and sent
to
should
be
voucher
retained in the office
treasury
or
stamped
with
payment
to prevent the possibility of
"paid and
cancel led”
after
immediately
payment.
double
The. genuiness of sub vouchers i. e., bills received^
from
firms should be verified with utmost care. The
DOO
the
see
only.
Wherever possible, it should be paid
payee
to
that the amount is actually paid
should
by
cheque.
Clear acknowledgement with date and signature should
be
impression
is
obtained
from the payee. Wherever thumb
obtained
it
should
be
got
attested
by
some
known
persons. It is suggested to issue only the acccwnt payee
1
0
When
reference
signing
the
to
vouchers and bills
sub
took,
cash
the
entries
wise
with
should
be
verified.
3
The
with
expenditure accounts should be got
reconciled
treasury on monthly basis. Regarding the
accounts
not appearing in the DDO's accounts but
appearing in the
treasury accounts, detailed verification has to
be
and
if there is any fraud, complaint should
with
police and information to be sent
to
>
be
done
lodged
controlling
authority.
EXPENDITURE
To
s
incur expenditure on works, there should
technical
budget
sanction
and
administrative
allocation.
The
DDO
procedure has been followed
the
current
SR
and
should
procedure
a
sanction
with
that
tender
see
and the estimates
the
be
are within
regarding
the
maintenance of muster rolls and MB, Contract ledgers
are
foil cv^ed.
account
Morrral 1
When paying the bills,
bills,
substantial
particularly
verification
running
is
done.
y there will be LOG system for payments on
works
expenditure
is
concerned. In such cases,
the
initial
accounts will be passed on to A.G.
directly by DOO.
amount
wi 1 1
be paid by cheques signed by
DDO's.
The
This
cheque books should be in the personal
custody of DOO' s.
■
I
BDO's should be very careful when signing the cheques by
not giving scope to fraud, which may taken place in
the
form of addition or alterations. Cheque writing machines
^ay also be used. When signing the cheque
■ entry in the cash book to be
corresponding
entered.
SAFETY OF £ftSH
The
lock
cash should be kept in cash chest with
system. Che key should be with DOO and
double
the
other
key should be with cashier. The duplicate keys should be
lodged
in
required,
book
treasury.
Chee in.a month or
as
often
as
the cash balance should be verified with
the
balance. The cash chest has ^6 be got-
ear
A
to
the interior walls.-
t
Regarding
Bank//Treasury
taken
transportation
to
of
office, sufficient
cash
care
by employing a reliable government
necessary
departmental
from
should
be
servants/'.
If
vehicle-may be used,
when
the
the
DDO
should obtain non-paymen^_cectificate_from treasury,
by
amount is large, with police escort.
When
the bills sent to treasury is lost,
requesting him not to make the payment - on the-lostjbill.
Thon
the
treasury.
duplicate bill may be prepared
and
sent
to
•aDejd sa>|e; Aew pnejf ‘Afjadojci auop ;ou sr asrojaxa
•japjo Xjddns aq} in
H
miM
aydiues
_JO
1 pa_4noQ_jd
IT
eq}
uaac]
pauoT^L^au
oar^EDT^TDads
pa^ediuoo
q^TM
seq SfETua^ew
aq
paseqa^rcj
pjroqs
t
ciaq^
•siu-JTj- qDEa ujouj. AnEnprAipuT uoiqEqonb aqq uiE;qo oq
pa^sad&ns
i' ’ I i
qy ajoj-ajaqx
st
I »• • i' ■• > ' • i i
• . I
) 1
‘ l ► ) I
*aauaqsTxa
| L'( ) I
) '
^oli suutj.
ut
‘•I!
qDFiS
.'U i I :
1 1!
1
*»»»1 q
I H ► M |
'*11' *n-1| H 11
■I •*1 "I I
I
fll I I I I I H I I |l I
■ 1 •• • • 1 ■ i' 'i •
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I
41-^wAud-UMu
.1 >1 1 k 1 1
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Illi.
1• I
|kl
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rit | |
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ru |
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■f • , . I
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'I
wfq qq
Un » 11
I
'I||| I :
*nbaqz)
qwqq .
-
•quatuasjnqsTp uoq
quroue
^4
wejp aj oq japuo quaajcuaAob yEToads
aqq
quaiuqjedaQ
aq± -aor^od
ST
>1Lrea
u^tm
aqi
fo pean
quas aq
uoTqeujjoj.uT
qsoy
aq
(
pabpoi aq aq seq qu-re^diuoD ‘uaioqs/qsaj
UJCJj-
paAyaoau
qSED
aqq
uaqM
•
pauTEqqo
uieqqo
oq seq anbaqo aqeoTydnp aqq
uaq±
c-i__
•anbaqd
aqq uo quawAed a>jew oq qou >jueq oq qsanbaj e
qqTM
>iueg aqq ujQjq pauTeqqo aq oq seq aqeoTqyqjaD quawAed-uou
^qd
■ '■
b)
‘qsoy
st
A_jnsea_uq iDQ.jj. paAiasaj anbaqo jaqq uaq^
t
!
QN FHQDLLENT ENCASH-ent of PILLS
In an office,
cash
orderly
the section superintendent along with
in collusion with the
treasury
official
managed to obtain the treasury tokens. They prepared the
duplicate
bills
on
signature of officer
They
managed
the DDO
account
and
forged
who used to sign on behalf of DDO.
to obtain the cheque
from
treasury
encashed from bank. This they practiced
for years.
the
treasury token number was not verified in
I
was
treasury
of fraud has taken place and the embezzled
in
terms
detected
of
early,
few crores.
if
,the
This
monthly
could
this
could
have teen detected through
or
internal
audit
internal
audit
sys tern,
n^ain-ly because the staff borne on the
by
of
subsequently
This
audit wing are not professional
amount
have
system.
bas not been detected
This
reconciliation
accounts was dene by DDO with treasury,
and
Even
office, due to the colusion of treasury officials.
kind
the
internal
accountants or auditors.
BQLE CF INTERWL AUDIT SYSTEM
Role of Internal Audit is to provide the
date to the management alongwith .performance
provide
for
al 1
advise and also conducts the
In
following are the -few important
internal auditors.
14
report.
concurrent
the wings of the organise tion.
departments,
financial
It
audit
govemmen t
tips
for
ifl.
I
1.
Comparison
o-f
allotment released by
Head
o-f
the
Departn^t to DDQ's with the return Df
expenditure
■From
DDO' s on r^cnthly basis.
2.
>
Comparison
of accounts return
from
DDO's
to
AG's
figures.
r
■ jle and proprietv aud;
4.
Bringing
■
to the notice of H3D about
eT.C-f
11^<=*
f in
Wlth
^pgestions.
consultation with the AG'S sta-f-f,
setting
right
*■
<3.' i d
>
l
chai Ians for detection
of -Fraud etc.
It is the responsibi1ity of HOD,
tnac.
the Internal Audit
professionals in the
To
^35 to be done
who is
of cash and raterials,
can able to detect and/or
detect.kms
15
an eye
on
so that he
to prevent the ■Fraud.
-0-
by
audit.
conelude, the DDO should
alv^ays keep
the inf]cx^ and outflow
nm' i-
“ing staff is ■filled up
area of accounts and
by
’I2
r
K.H.S.D.P.
hospital management TRAINING
EOR CHC DOCTORS
Day 4 : IS-12-1997
12 00 Noon to 1 00 PM
Waste Management and Cleanliness of the Hospital
- Dr. Sathyanarayana
)
Cleanliness of a health care facility eg. Hospital or clinic, is as important as the
health care that the facility offers. Increasing health care activities in hospitals and
clinics generate, as a by-product, a large amount of unwanted materials called ‘Medical
Waste’. Wound dressing, surgery, deliveries, investigations, autopsies and a host of
procedures and therapies produce different categories of wastes. These ‘biomedical
wastes’ have proved infections and hazardous. Indiscriminate dumping of these wastes
and hazardous. Indiscriminate dumping of these wastes have resulted in a number of
nosocomial infections some of which have been fatal.
To-day, the health managers of hospitals and clinics, specially the
administrative heads, would like to look around their institution and ponder whether
their health care facilities invite or stun away the patients.
t,
Hospital Waste Management or Health Care Waste Management has been a
subject ignored so far for a variety of reasons and lack of policy, awareness,
commitment, resources. The result rendering a quality health care given by qualified
personnel ineffective because of an unpleasant if not filthy environment. The enclosed
synopsis on Hospital Waste Management gives an outline of essential facts about
hospital Waste and its management The panicipants who are not only managers but
also trainers would find it useful as a teaching material to train other health workers in
their own institution.
CoiisulLim (STEM) KHSDP
VVIuit is IVTccIicuI Wosfc?
Medical Waste is waste generated in diagnosis, treatment,
picvention 01 research of human and anima! diseases. The
waste can be in the form of solid or liquid waste.
Where is it generated?
Hospitals, health centres,, clinics, nursing homes,
midwifery, laboratories, research institutes, veterinary
climes as well as from medical care conducted at home.
87
M/
r Y ti J
XC?
rtz
3»
MP
imnortan^?
JL * * *
6-W A. M.
•
1. Medical waste presents occupational health risks to
those who generate, handle, treat and dispose of the
waste.
2. It may also presents risks to the community or
environment if the waste is inappropriately handled,
since it can contribute to the spread of diseases. Viral
transmission of Hepatitis B, Hepatitis C and HIV
through injuries caused by syringes or sharps infected
with human blood.
88
Why is it important?
1. Medical waste presents occupational health risks to
those who generate, handle, treat and dispose of the
waste.
2. It may also presents risks to the community or
environment if the waste is inappropriately handled,
since it can contribute to the spread of diseases. Viral
transmission of Hepatitis B, Hepatitis C and HIV
through injuries caused by syringes or sharps infected
with human blood.
88
■fc>'
3. The risk associated with the use of incinerators. The
smoce produced by infectious-hazardous incinerators
may contain toxic particles that can effect people’s
health.
11QP
Classification
WHO Classification - 1987
WHO simplified classification - 1994 - developing
countries
US - EPA classification - 1989
India - classification - 1995
89
«
m
-W
Z-X
0
4. •
"W
*
a
S>0M
900
□ cgi c^ciliUii ill
0
a a*
a b
ax.
■x. • a
a 0 b
b
B
a *• a
“= ja
HIV OUUIVL
Segregation means separation of different categories of
wastes by sorting and putting into different containers or
bags at the place where waste is produced.
Blue Container
Red Container
White Container
Clinical Waste
Infectious Waste
General Waste
Labeling.
90
Collection
rl intni1 *n
.. o I
Ifi
nai
it It Vi
ti iilisportlion
• Using trolleys or carts.
• Moving waste from one point to another within the
facility.
Storage
• A specified area within the hospital or facility’s
compound, designated exclusively for the storage of
medical waste for a short period of time before
treatment or disposal.
91
o
•s
Treatment
Process that modifies the waste in some way before it is
taken to its final disposal place. Reasons:
• to disinfect or sterilize the waste so that the waste is no
longer infectious, after such treatment the waste can be
handled more safely with fewer precautions;
• to reduce the bulk volume of the waste in order to
reduce the volume before disposing it to the final
destination;
• to make surgical waste or body parts unrecognizable
so that it will not be unacceptable to the community;
92
• to make
unusable.
X
Jf
1 ci ly 1 v-
Jt L Cl 11 o ?
onp h
O UVil
oo
CtO
needles,
Various treatment methods:
Incinei cition: a process of burning infectious-hazardous
waste under controlled combustion, the end product will
be sterile residue and emissions.
Regional Incineration: One well-run, state-of-the-art, air
pollution-equipped incineration is better than many small
incinerators.
93
w
Microwaving:
the rprocess
incorpor
o
1
spraying and microwave irradiation.
U
cPrpUHiinrr
oni C viLii
QTPQm
Autoclaving: is a system to sterilize medical waste by
using autoclave or steam sterilization.
Chemical Treatment: the process includes preliminary
milling and shredding of the waste, washing it with
chemical disinfectant, and then going through a de
watering process to limit the moist.
94
External Transportation
It is the transportation that carries infections-hazardous
waste from health facilities to an outside treatment centre
or landfill.
Final Disposal
Final Disposal means to place the waste in its final
resting place.
Safety handling
Preventive measures: Hepatitis B vaccination, universa
pi ecautions, personal pretective equipment etc
95
eee s
o
n
«•
©
•s
Project support:
• State level
• District level
• Facility level
96
HEALTH MANAGEMENT INFORMATION SYSTEM *
Date : 17-7-98
2)- hl
Time : 9 to 10 AM
The MIS varies according to the structure of (he system and has to cater lo the
organisational needs of a) Research b) Planning c) Policy formulation d) System integration
and e) Implementation and maintenance.
2. Health is a holistic concept and a confluence of many sub systems. HMIS has to fulfil
the following mandate.
>
J
1) Describe the level of community health
2) Diagnose community ills and priorities
3) Promotion of legislation
4) Formulation of Programmes( Eg. : AIDS control, RCH)
5) Dissemination of information for Health Education
6) Planning and Evaluation
7) Projections(Eg. : Population)
3. Data/Information is the life blood of Management and is essential at all levels of the
organisation
9
)
a) for reporting to the next higher authorities and
b) for monitoring and review. It results in action and corrective measures at all levels.
4. Health system in the country - Ministry of Health & Family Welfare (coordination and
policy making) -»DGHS Technical Wing - Medical Care and Public Health
CBHIfNodal Agency for HMIS)
State Health & Family Welfare Departments( +
Medical Education) - SBHI - Demographic & Evaluation Ccll(FW & MCH) or (RCH)
5. Rural Health set up
- SC - PHC - CHC
)
K 6. Information on Medical and Health care is mostly availble for public enterprises only very’ little information in respect of private sector in spite of significant contribution(82%).
NGOs also are contributing to Public Health Care and Family Welfare activities to a great
extent.
7. Health Programmes
a) RCH(FW + CSSM + STI/RTI)
b) Malaria Eradication
c) Tuberculosis
d) Leprocy Eradication
e) Control of Blindness
t) AIDS
g) Nutrition
h) Communicable Diseases
)
•
o v.uxr.t^xi
y.
(NICNET)
Communication Network
Information Svstem(DISNIC') T r /i'IC I'npila,S a'ld l!lc cc,lltW facilitating District
Central Gove^X« "
CSSCn‘lai
Stated and
Renters to be maintained at PHC level
1. Sub-centre Register - 1
Sub-centre and Village Information
2. Sub-centre Register - 2
Household Information
3. Sub-centre Register - 3
Eligible Couple & Children Infonnalion
•+. Sub-centre Register - 4
family Welfare Services
5. Sub-centre Register - 5
Maternal Care Services
6. Sub-centre Register - 6
Child Care & Infonnalion Services
7. Sub-centre Register - 7
Tuberculosis & Leprosy Control
Sub-centre Register - 8
Malaria Blood Smear & Treatment
9. Sub-centre Register - 9
Home visit Diary
10. Sub-centre Register • 1C
- 10 Clinic Register
IE Sub-centre Register - 11
I Stock & Issue Register
12. Sub-centre Register
c ,
- - - I2 Vital events - Births
13. S
*
hub-centre
Register - 13 Vital events - Deaths
10. Reports to be sent by the PHC
f amily Welfare
1) KDP Report
2) Ponn-14(Now replaced by 7)
3) OP & CC. IUD Reports
4) Stock position of OP. CC, IUD
5) Quarterly reports - (Socio’Dcmographic Data)
) Sterilisation death(Quarterly)
Ji MTDf??On aftef SteriIisation(QuarterIy)
*) MTP(Monthly)
Eligible Couple Analysis
10) Age wise and Children wise
Sterilisation Reportsfonly for sterilisation)
immunisation (LUP)
1) CSSxM renoralMomhly;. Pneumo™, 0RT epls<)(te. D„rM10ra|
2) MC1-I repons - 1) Special report (Deliveries, IFA Tablets) Moml,Iy
2) Infant & Maternal deaths
3) School Health
4) Dais Training
3) Leprosy - 1) Survey reports (Monthly)
2) KDP report
3) Form U. L2?and L3
) i lalaria - Passive and Active ReportsfMonthly)
f
(
Lab report(Weekly 'Monthly)
5) 'I P,
■ sputum collection and case detection
Stock Position of drugs
I
0
NPCB
Cataract Operation, Survey Report(MLY) Total Operations and Refractions
Nutrition
1) ICDS report (Monllily) Project advisors report and sectored advisorc report
2) Iodine dufceicncy - Goitre control programme
3) Vitamin - ‘A’ report
4) NED(Nutrition, Education and Demonstration)
MEM(IEC reports)
1) Mahila Arogya Sanghas
2) Exhibitions
3) Film. Shows
4) Folk media
J
CMD(MLY)
Indoor and outdoor patients
JE & GE Casus
Dengue fever. Snake Bite, Dog Bite
Morbidity and Mortality report
AIDS
RCH (Reproductive and Child Health services)
Under RCH Programme, the approach to Famih^ Welfare is Community Needs
Assessment Approach. Under this, a set of new formats have been prescribed.
Accordingly, the Annual Action Plan is to be prepared in Form No. 2. The monthly
progress on various scrvices/activities as also the stock position of drugs, vaccines etc., is to
be reported in Form No. 7.
b?
*
Prepared by Shri. G. Prakasani, Joint Director(Demography), Directorate of Health &, Family
Welfare Services. Ananda Rao Circle. Bangalore 560-009.
>
)
Definition of Management:
Management is a distinct process consisting of activities of Pl
Cooking performed de.ermme and accomplish siaied ohT
T
Of human beings and other resources.
Popularly Getting things done through other people ”
Six M’s of Management of “basic
u resources” are subjected to the fundamental
functions of management.
Basic Resources
Fundamental Functions
Objectives
The 6 M’s
The Process of Mgt.
Stated
End Results
Men
Materials
PI.anning
Aerating
Organising
Controlling
Machines
Methods
Money
IMarkets
INPUTS
r
>
PROCESS
OUTPUT
J
Manager, is 6Ktil,g
righ,
done „
___
persons with right amount of resources and with eSective use of resources.
^touNeed.Management?
Human efforts more productive
Brings better equipment, plants, offices, products
relations to society
and services and human
Improvements and progress are the constant watchwords.
•
Brings order to e„deavours by
i ormation into meaningful relationships.
•
Accomplishment of many sociai, economic and pditical goals of any country
I
MANAGEMENT
CONCEPTS
PRINCIPLES
FUNCTIONS
APPLICATIONS IN HEALTH MANAGEMENT
Dr. Kishore Murthy
3)3
Management: Is it Art or Science?
Management is an ECLECTIC DISCIPLINE with elements of art and science
combined.
Body of systematized knowledge accumulated and accepted with reference
to understanding of general truths concerning Management.
Art of Management is a personal creative power plus skill in performance.
Science teaches one to “know”, art teaches one to do . Management is to know
and do things efficiently and effectively to be successfill with the proper resources.
>
Technical, Human and Conceptual Requirements;
Top managerial jobs require more human and conceptual knowledge and
skill
than technical knowhow.
Lower jobs require more technical and human needs with less emphasis on
conceptual work.
Organisation
Levels
Conceptual
Top
Human
Middle
r
Supervisory
Technical
Knowledge & Skill required
Key characteristics to understanding Managementl
1.
Management is purposeful and Management makes things happen
2.
Management is an activity, not jut a person or group of persons
3.
Management is accomplished by with and through the efforts of others.
4.
Management is usually associated with efforts of a group
5.
Management is intangible
6.
Management is aided, not replaced by computers.
7.
Management is an outstanding means for exerting real impact on human
life.
Planning
Organising
What is to be done where ? When? How?
Who is to do what? With what
Relationships, What authority. Under
what Physical environment ?
Actuating
Controllin.
Getting the Employees to Want to
Work willingly with good co-operation
Follow up to see that planned work
is being properly carried out and if not
to apply remedial measures
N0T STATTr
Ime2aal0^^
function of mana.
;ement
Planning
Clarify, amplify and determine objectives
Forecast
Establish the conditions and assumptions
under with the work will be done
Select and state tasks to accomplish
Organizing
Break down work into operative duties
Group operative duties into operative
positions
Assemble operative positions into
manageable and related units.
Clarify position requirements
objectives.
Establish an overall plan of
accomplishment, emphasizing creativity to
find new and better means for
Select and place individual on proper job.
Utilise and agree upon proper authority
for each management member.
| accomplishing the work.'
Establish policieies, procedures, standards
and methods of accomplishment.
Anticipate possible future problems
Modify plans in light of control results.
Provide personnel facilities and other
resources.
Adjust the organization in light of control
i
results.
?
I
I
3
§1^
)
Actuating
1
y
Controlling
Practice participation by all affected by
Compare results with plans in general.
the decision of act.
Appraise results against performance
Lead and challenge others to do their best
standards.
Motivate members
Device effective media for measuring
Communicate effectively
operations.
Develop members to realize full potentials
Make known the measuing media
Reward by recognition and pay for work
Transfer detailed data into form showing
well done.
y
Satisfy needs of employees through their
Suggest corrective actions, if needed
work efforts
Inform responsible members of
Revise actuation efforts in light of control
interpretations.
of results.
*
comparisons and variances.
Adjust controlling in light of control
results.
The components of results management
1 • ESTABLISH OBJECTIVES
a. Identify key areas
b. Determine measurement unit
2. PLAN ACTIONS TO BE TAKEN
"
a. Decide necessary activities and tasks
to be done along with respective purposes and means
for accomplishing.
b. Determine sequence of actions, what resources are
needed, time needed to accomplish each task, and
who is responsible for it.
c. Anticipate potential hurdles and decide what might
be done to overcome them.
3. CONDUCT PEREIODIC AND ANNUAL APPRIASAL REVIEWS
a. Look over objectives subordinate is responsible for periodically.
b. Review actual results obtained.
c. Evaluate results against performance expectancies as set forth by
objectives that were established and establish revised or new objectives
Management with reference to Medical Officer of Health:
Getting things done by others in a systematic way to achieve the predetermined
goals. For eg. given the responsibility of implementing the health programmes, the
PHC Medical Officer has to plan various tasks, divide the work among his staff,
provide support and supervision so that the ultimate objective or target is achieved.
Thus the MOH necessarily acts as a manager in order to get things done through
his/her staff.
A medical officer at PHC is both a technical person and a manager. One must be
able to differentiate between these two roles. As a technical worker the medical
officer is doing some of the following :
1.
Diagnosis and treatment
2.
Prescribing
3.
Follow-up treatment
4.
Any other form of treatment
5.
Preventive and promotive services
6.
Giving clinical knowledge to his staff.
As a manager, the medical officer is doing some of the following:
1.
Planning, organising and evaluating the activities of the PHC
2.
Supervising the staff
Maintaining adequate supplies and equipment
4.
Supervising information gathering and recording
5.
Managing the PHC vehicles
6.
Solving problems
5
^1?
3
J
7.
Financial administration
8.
Motivating the staff and providing leadership
9.
Developing staff capabilities through training
10.
Developing good relations with community
One of the problems a medical officer faces in being a PHC manager is a sense of
frustration that he is not accomplishing as much in his managerial role as he is
accomplishing in his technician’s role. A few medical officers get so frsutrated
with this feeling that they develop a negative attitude towards administrative and
managerial functions.
Other medical officers tend to ignore management
responsibilities and feel comfortable only treating patients.
Still, other medical
officers delegate all administrative responsibilities to their staff and then forget
about them. -It is important that medical officers realise that they can influence the
PHC’s prformance a great deal through appropriate management and thus provide
better health care for a community.
Difference between a medical officer’s technical and managerial roles:
1.
A doctor can observe the results of treatment in a short period of time.
Whereas, a manager may have to wait for longer periods of time to see
results or improvements.
2.
In general, a doctor works alone in his clinical activities, whereas a
manager depends upon several other staff and works as a member of a
team. For many medical officers it is easier to work alone than to work
on a team.
The results of performance as a doctor may be more visible and have
higher status than the results of performance as a manager.
4.
A doctor has a one-to-one relationship with a client and therefore direct
control over the client. Whereas manager works through his staff and
does not have a one-to-one relation with his client.
5.
A doctor may have to face motivational problems as often as a
manager, both self-motivation and motivation of staff.
C
Functions of the MOH
Any organisation is like a pyramid, and at the vertex is the Chief Executive or
MOH, whose administrative functions are summed up by Luther Gulick in the
word ‘POSDCORJB’ which stands as follows:
Planning
Plan the work that needs to be done and the method, how it
should be done.
Organizing
giving the plan some shape and establish the formal structure
of authority through which work sub-divisions are arranged,
Staffing
the whole personnel function of bringing, training
and maintain favourable conditions of work.
Directing
The continuous task of making decision and giving
instructions.
Coordinating ...
the all-important duty of inter-relating the various parts of
the work.
Reporting
keeping those to whom the executive is responsible
informed about the progress and also keeping himself
informed through record returns and inspection.
Budgeting
with all that goes with budgeting in the form of fiscal
planning, accounting and control.
Planning:
Planning is selecting information and making assumptions regarding the future to
formulate activities necessary to achieve organisational objectives.
Advantages of Planning:
1.
Makes for purposeful and orderly activities.
2.
Points out need for future changes.
3.
Answers ctwhat if’ questions
4.
Provides a basis for control
5.
Encourages achievement
6.
Compels visualisation of entirety
7.
Increases and balances utilization of facilities
8.
Assists manager in gaining status.
7
Types of Planning;
r
I.
Strategic planning (Long Term Planning)
2.
Tactical Planning (Methodology Planning)
Strategic Planning:
1.
Answers :
Where should we be going
2.
Defines;
Enterprise purpose served and its preferances
3.
Analysis:
Environmental factors influencing the operations, constraints
and opportunities revealed
4.
Determines:
real abilities of enterprise management, ability, finance,
sales, production skills
>
5.
Selects:
Strategic objectives
6.
Documents:
Strategy
Tactical Planning:
r
)
A
1.
Answers
How will we get there
2.
Determines
tasks to be done
3.
Establishes
who is responsible for what
4.
Allocates
resources
5.
Sets
quantitative measurements for each task
6.
Puts tactical plan in writing
7.
Perform planned actions
8.
Exercise controls (Monitoring)
9.
Evaluate progress
Strategic Planning
It is the process of deciding on the objectives of the organisation or changes in
earlier specified objectives on the resources used to attain these objectives and on
the policies that are to govern the acquisition, use of disposition of these resources.
Strategic vision accomplishes the organisation goals and objectives, apply criteria
to day-to-day operational decisions and involve people to be part of the overall
design.
Characteristics:
1.
External orientation : Opportunities and Threates
2.
Futuristic Action orientation : What is likely to happen and what is possible
to
make it happen
3.
A long term plan
4.
Closely tied to the budget.
t
StgBS_for Strategic Planning'
I.
n.
Conduct SWOT (Strenghs, Weaknesses, Opportunities & Threats) Analysis
a.
Analyse the external environment
b.
Analyse the internal environment
Set objectives in terms of services to be provided, client segments,
coverage, channels to reach
Set objectives that are SMART
•
Specific : everyone will interpret them in same way
•
Measurable to monitor progress/evaluate performance
•
Appropriate to your organisational policies, goals
®
Realistic given limited resources of money, manpower and materials
Time bound, so resources can be allocated
planned to meet the objectives
and activities can be
Overall view of planning and its relationship to the management process
Planing
A systematic throught process
Strategic
planning
)
t
Tactical
planning
Purpose of enterprise
Technologicafsociological
and governmental influences
Characteristics of market
Demand for product and
service
Resources ofenterprise
Competitive position
Policies or plans
giving guides and
restrains to the
planning
<■
Sales Forecast
Number and type of customers
Establish who is responsible
for what
Allocate resources
Set measurements for each task
Creativity:
Particular
plan
*
* New Ideas and
relationship
WHAT action must be taken?
WHY must this action be taken?
WHERE shall the action take place?
WHEN shall the action be taken?
Analyze
alternative
actions
WHO shall be responsible for the action?
HOW shall the action be taken?
Revision of the
particular plan
•>
Reevaluation of
short-run, intermediate,
CORRECTIVE
ACTION
and long-run objectives
Subsequent information
and forecast
Organise
>
Actuate
>
Control
/0
Health Planning may be defined as deciding how the future pattern of health
1
activities would differ from the present, identifying the changes necessary to be
accomplished and specifying how those changes should be brough about as to
usher in overall health development of the community.
Purpose of Planning’
1.
To match limited resources with many problems
2.
To eliminate wasteful expenditure or duplication of expenditure
3.
To develop the best course of action to accomplish a defined objective.
Purpose of Health Planning in particular:
To improve the:
1.
quality of health care
2.
efficiency of health care
3.
adequacy of health care
4.
equity in health care.
Example of Faulty Planning:
In the corridor of a District Headquarter, an unopened crate was lying for more
than 2 months now. When enquired as to what is contained, it was found that this
was ILR which has been received. As to why it was not being utilised, a M.O.
reported that there was no District Immunisation Officer to take charge. Moreover
it has been donated by a donor government.
On further inquiry, it was discovered that the ILR had been received but plans for
its location were not made and approval for appointing an operator was not
secured. This was discovered only when the ILR arrived. The paper work had
now been completed but it would be at least 6 more months before all the
approvals could be obtained. Clearly failure to plan and take coordinated actions
had resulted in non-utilization of the ILR which was badly needed.
Such examples of failures of planning abound. Planning improves performance by :
1
matching services to people’s needs
2.
efficiently utilizing resources; and
II
NF
3.
coordinating activities to achieve desired results.
be effeci.ve .n
Bu. for pimri„g
' Cntlfy key resu’t areas and prioritize activities,
b) provide sufficient flexibility to respond to local variations,
c) be realisitic and feasible,
d) enable itnplementers to implement the plan by providing necessary
resources, and
ate implementers sufficiently to carry out the plan.
The Planning Process in Health:
qeu^oZ"* °f “ effeCt,V' Pla'”i”S ta health“ "SW'™S
1. Where are we no
fono™8 l»y
(Situational Analysis)
2. Where do we want to reach
(Goals, objectives, priorities, targets and
strategic decisions)
3
How well we get there
(Organisational constraint, resources and
organisational structure, functions and
managment)
4. How well we have done
5. What new problems do we have
I
sups for plimiin8
health
Monitoring (evaluation and feedback)
(Replanning)
„„ different than
A IlCSC 3Ft?,
T Health station analysis of the area to assess health problems, health resources
■ <D-
opportunities for action by collecting data through available sources and
iW
conducting baseline surveys.
( *
Establlsh health priorities of the area
( •
J
obZcXs^
fOr aCti°n Within natiOnaI heaIth Plan Objectives and prog™
<V
( «
(I
tv
o
€»
4. Setting targets for action
5. Identify tasks to be performed
12-
f
**
i
*1
Planning Tasks:
The following table presents Planning Tasks at Different Levels of Management:
Level of Management
Planning for
Planning Tasks
Top
Strategic
- Developing strategies
Outcome
- Negotiating goals
■
*
- Allocating resources
Middle
Operational
input-output
- Planning for service
delivery
- Negotiating targets
- Logistics support
- Mass communication
- Coordination with other
development departments
- Encouraging community
participation
Operating
Operational
- Home visits
Activities
- Follow-up
- Field worker activities
- Supervision
- Clinic/Health Centre
Operations
- Record keeping
SWOT Analysis:
Assess the external environment to see how it will affect the organisation as well as
how the organisation can influence the environment. In other words, identify the
constraints (or threats) and the opportunities through systematic scanning of the
environment.
The external environment may consist of a number of social,
« i
< i
I I
political, technological and economic influences.
#>
Assessment of the department’s internal strengths and weaknesses, after scanning
the environment, one must turn inward to see how the program is performing in
I >
o
O
3^)
Common problem areas for Managers:
1
9
>
1
J
1•
Decision making
2.
Costs
3.
Employee recruitment/selection/training
4.
Finances
5.
Management Information systems
6.
Inventory Records
7.
Supervision, morale, motivation
8.
Quality control
J'3
Possible managerial actions to solve management problems arranged by
fundamental functions of the management process :
A. Planning
1. Objectives of individuals
2. Objectives of the enterprise
3. Policies covering authority, prices, attitude toward competition
4. Procedures - specific means of handling paper and products
5. Internal programs
B. Organising
1. Span of authority
2. Delegation of authority
3. Use of staff and service groups
4. Informal groups
5. Integration of structural activities
C. Actuating
1. Leading
2. Developing and evaluating employees.
3. Fulfilling personal needs through work satisfaction
4. Job enrichment and enlargement
5. Supervising.
D. Controlling
1. Establishing standards of performance
2. Measuring work performance
3. Improving rate of return on investment
4. Developing adequate budgeting
5. Employing better cost and quality controls.
Managerial problems in Health:
1.
Non-achievement of targets for all programmes.
2.
Insufficient and irregular supplies including drugs
t
Lack of properly trained health personnel
4.
Difficulty in supervising peripheral areas due to terrain
5.
Lagging behind the implementation schedule.
on lack of transport
Problem Analysis
At this stage, an important
onportant quest.on
question would be on the process through which one
could lay hands to the relevant problem. Table 3 .4.2 may help in orienting towards
adopting a step by step method for problem analysis.
Incident
The situation/
- What is or is not?
Happending
Hypothesis
The problem area
- Define and set limits/
boundaries
Data
The information,
facts and figures
3
Qualification
- Calculation and analysis of
relevant data.
Tangible and
- Measurement: Values and
intangible factors
Weightages-Absolute or
Relative
'>
Expectations -
Object!ves/Results
- Musts and Wants
Options
Alternative
- Identification and
Courses of action
Search
1
Choice
Risk
Selection of
- Desired result/
appropriate choice
satisfaction
Evaluation/
- Expected benefits and costs
Anticipation
and adverse future effects
Acord
Acceptance by
- Individual vs. group
affected group
Action
Implementation
interation
- Responsibility and
Accountability
delineation/assigning
Monitor
Follow Through
- Constant Review &
Direction for
Corrective action
or strategy
For example you find a situation wherein the district only 40% of the deliveries are
ensured to be safe, as those were conducted either by the trained personnel or
institutional. You may think of the following causes :
1. Workers are not going for required home Visits
2. Health workers (female) do not stay at S.C. beyond their duty hours
3. 30% of the villages do not have trained dais.
4. Community has not been able to perceive the trained dais and Health Worker
(F) to be more effective workers than the traditional dais.
5. Community perceives deliveries as natural phenomenon which involves no
greater risk to the health of the mother and child and do not consul HW(F).
6. High risk approach and mandatory referral of such cases is not being practiced
at any level.
7. There is only one district hospital (women_ and one CHC in the entire district
and no obstetrician and gynaecologist is in position at the CHC.
8. Transport and communication facilities are not good in the district
9. Even in the district hospital average length of stay is 8-10 days and 80% of the
cases admitted for the delivery are normal ones.
Al
"5
As a district health officer your problem is to increase the coverage of safe
deliveries by trained personnel and utilise the hospital and CHC for referreal of
3
high risk and complicated cases. The solution to the problem may be :
a) Strengthening referral services for MCH cases at high risk
b) Training health workers and dais about high risk approach in MCH with an
adequate system of supervision.
>
c) Providing disposable delivery kits and regular replenishment of this for workers
so that they can conduct safe deliveries.
d) Organizing EEC activities to inform the community about the facilities,
personnel and advantage of getting deliveries conducted by training personnel.
3
e) Ensure the availability of Health Worker (F) and their supervisors at their work
place by making them to stay there beyond working hours.
f) Strengthening the system of preventive ante natal visits at home.
g) Emphasizing on the concurrent visits by the health supervisors (Female)
h) Opening of new CHC, with Junior Specialists in Obst. and Gyne, or at least a
lady medical officer.
These solutions indicate that the problems may belong to
(a)
Planning
(b)
Direction and supervision
(c)
Monitoring and evaluation
(d)
Organising and implementation of services.
Therefore the nature of the problem may be determined by the analysis of the
situation and feasible solution.
)
33
The key points to be noted here are :
i.
The problem classification is not done on the basis of symptoms but on
alternative courses of action that may be feasible.
ii. Each feasible alternative needs to be evaluated to get an estimate of the likely
outcome if the particular alternative is taken for implementation.
iii. For analysis of alternatives one needs a scientific approach.
iv. The analysis should be based on facts and not shrouded by myths/assumptions.
v. The best course of action is chosen after detailed analysis of all the feasible
courses of action.
vi. Each one of the above steps must be explicitly governed by the organisational
goal being pursued.
NATIONAL AIDS CONTROL PRpnRAMMe
^3?
tho
*-it Lon Al MO., Control P mo r arann
the State as p,-,r ttie Guidelines of MaMonnl 15/ ’. hnjfiq ‘Ijlip 1. f'llK’ll t'Vl j fl
ion, Ministry of Health and Family Welfare i’T>'9 Control Org.-mi saCovt. Of India.
is a 100% Centrally sponsored Scheme.
1
I
OireatoJX^THeaUh ^J1^.^rS^X"^nKo""? 1
199?, in the
1 supervise
t e activities under various
various components of Nannnnl
Programme.
The State
Level empowered
1 aids Control
'The
State Level
•on.st
it uted
under the Chairmanship
of Health
Heai h rSecr-tarv c^
•
Chairmanship of
and Karnataka State
AIDS
Prevention
S^cToL
Cov
:
rr
’
me
nt
of
Karnataka
------- j AIDS# Prevention
1997,
-Jition oocinty is form©
d durinn December
SURVFILI.APCE AND CLINICAL MZvNAGEl'FNT
taking-up Surveillance’ and'.Unt inel^prve'ii are
1™ functir,r,ina wl>.lch
tak±ng-up Surveillance
Victoria Hospital, Bangalore,
Bangalore National
t nst
~'
T,
National'i
Neuro-Sciences, Hosur Road
1 nT‘ °f Mnntal Health and
/' Bangalore;
Manipal.
°
Banr-?lnre; and Kasturba Medical College,
9L00D SAFETY PROGRAMME
r-
i
Ten( 10) Zonal Blood Testing Ccntroc
functioning, all the Blood Banks ? o'
6re n5tabl l.shed and
Voluntary Blood Banks
linked ’e• Go^rn^nt, Private and
for Screening for HIV to ensur« Blood TrZ 7j?na.
1 Rlood Testing Centres
Banks have been Modernised by way o?\u
! of no
52 Blood
consumables in a phased manner. Y
SU?p1^ of ^uipments and
One Blood Component Ser>orai-<on r
Facility j.q sar’ct'jon»4 and
during 1994-95
- — _ -Inst. of OhcoIoqv,
B"ntSS!a '’“rlng ”91-’5
1
SEXUZvLLY TRANSMITTED DISEASE CONTROL PRO'U?M ime
The service c
Ca7TeaeMn ^iqt4n^30
Clinics attached’
to major Hospitals and T
drurvq
9
are
str
'
?n
Gth
‘=>ned by way
of supply of equipments., drugs and laboratory supplies,
y
INFORMATION, EDUCATION and COMMUNICATION
i
Control ProqrImmeaisOintensifiedntonrreOt?nUniCatiOn unf^r Ayr)s
Community, Television snots and n °
reate awaceness among the
'>>■■■>',<1'' All i„ai. sialo "atr^
.S t"' h,ln?
tributed.
are taken
non-government organtsamon co-ordination
out of th?rl™7S F'on-Govprnmental Oraanisatiors
^,n f thiS 20 ar“ suPP°rted Financially, to tak-are ronistered
campaign on AIDS. ,
y
taKe up awareness
TRAINING PROGRAMME
Training Programme is being coraanised for Medical Officers,
ara-Medical Staff and Non-Gov^rnment
nt Organisations.
. .2
i
2
As on end of 31—3-1998, 386233 Blood Samples have been
screened. Out of which 3818 are found HIV positives, 136 AIDS
cases and 69 have died (from 1987 to end of March 1998)
Sentinel Surveillance activities were tak^nup as per the
approved protocol of National AIDS Control Orqanisation at:
1. STD Clinic - Victoria Hospital, Bangalore
2.
-do- Karnataka Medical College Hospital, Hubli
3. ANC Clinic -do4. STD Clinic - C.G. Hospital, Davanagere
5.
-do- Govt. Medical College Hoscital, Bellary
6.
-do- District Hospital, Gulbarga
7.
-do- K.R. Hospital, Mysore
8.
-do- District Hospital, Belqaum.
The following category of staff have been trained during
the year 1997-98
SI.No.
1
2.
3.
4.
5.
6.
7.
8.
. 9.
10.
'.11.
12.
No.
trained
Category
250
140
10
20
50
Private Medical Practitioners(Dist. Level)
Faculty Members of Private Medical Colleges
Laboratory Technicians of Blood Banks
Social workers
Health care providers for Childrens and
Non-Governmental Organisations (2 days)
Physicians of AIDS Control
STD Clinic Doctors
Staff Nurses
Blood Bank Medical Officers
Hospital Administrators'
DentalSurgeons
Key Trainers Training by IMA-2 days
20
20
20
9
50
240
250
FINANCIAL RELEASE BY NATIONAL AIDS CONTROL ORGANISATION
GOVT. OF INDIA
RS.
YEAR
1997—98 upto end
of March 1998)
IN LAKHS
ALLOCATION
Rs.
417.01 l-akhs
'
EXPENDITURE
Rs.
218.76 lakhs
----- -——^^£121*11
----- - ------- -Sr's-.Trn-p-r,
-------
■>
___ 5.F object -to
....
from
7~~~—“7
from
L
c en t r e s T'
mLLC-LiMo f -report -up~0 -end^F^
—wLr?98_____
J?.—Se ^^^jTTTKcZSToTT---- 7------
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° ™”a... 19 82 '_____ M Y . 19 9g
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072 2-~
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M
___ IfitiLZ
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i i ,
__ LbJ Oj-h e_FT~S tTIT s
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8
~
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k -1--------
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s e F^“737TT M e M
----- -- —a-*—i-rr—*>t
a s r r- t
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-rrrr__
---- *——_____________ ’
—VL-~ m 55 r f? “ 5 " 5 ~ rju* - ’“££172mrZ
r~tz^'r_'r“r —■’------ --- -_____
-.3—6.1.0□$i_£0(1o£s _
-sn —-i-irarr-—£-------15-5-g TrirrrrjD*-r - -"-£
----- 13. 0 6__
* t 3.33________
£h7r 7
— *—- 57 ~775u 7"i~— e.21
r—____ 45
-1..13
'ur:^
3 - V.s£s.
~r ~p__
- _ 1
—:_.15 89
4 0.0 0
7^CC-S^^esj-xt-rrr:3-.z-£-LE*--3_--
—I2F-7ij tiyg_y?.£.Li_______
I M kH Z
~s
—23 X
“ C
~“~=====-=2S3* .
...13
~
'.j
11’
r- = — M
- 0. 33
’==’ *
e r.
=?
hd’
; 2 • ■ A o. 1 ■ h o ------
-----
..rc-Jt-inaJ.
_____
4 .
Ye arwise Blood
Samples
screened
•for
HIV ^ve ..
Death 2 due 71t o
'Year ; ,
o_o d J_1. ■
; I •Samp Ue s
i t ives
——
,2
. - : •
A I D S_ c a s e s
_
■"7rrr"E",.-“T“r" = -r.“c!Tr-:
19 8 7
"9 13
19 8 8
272 6 4
6
2
2
T19 8 9
2 5“ 9 2 8‘~
3 2“
1
1
•'f9 9 0
•48z348
1
1
: 1991 •
. '66 z828~
1
1
'
■
•
/
aIds
-ri.
•
i
58
86
i
"19'9:2 'M , 02,3'36
168
2
2
~19.9 3
17 6’; 2 3 7.
...--868
9
9
19 9 4
2 4‘z 2_0 9
425”
15
13
'19 9 5'
1'175 8'3
439
’ 12
12
i^T"
“8T877-■
697
.22
7
19 9 7
15 4 52
847 "
■347'
— 4^-^ e* •»
58
17
.
J.OTAL
378 8;_5 6 6?
__ 6_____ r..<___
.Z.i----- -
•jBl'oo.d
s
^7.
terms of meeting its objectives with present strategy and whether it needs to
change strategy. This should involve not only appraising the objectives, but also to
its other organizational functions such as administration, education, services,
3
management of financial and human resources and general management.
This type of analysis is called “SWOT” analysis.
1
(It deals with Strength,
Weakness, Opportunity and Threat). To illustrate those are described below for a
Health Care Organisation:
T
i.
3
Opportunities:
Forthcoming participation from the community and NGOs to the health sector.
n. Levels of rising awareness of the community towards health care services and
facilities.
iii. Involvement of support manpower as potential partners in health care.
iv. Development of integrated rural development services and women and child
welfare programmes in the rural areas.
v. Improved provision of safe water into the remote and difficult villages.
vi. Increase in the literacy among women and-the population in general.
*
vii. International collaborations in health.
viii. Opening of large and specialised hospital in the private sector.
ix. Growth of insurance scheme in health care.
x. Adoption of appropriate technology for health care delivery.
t>
xi. In community, growing acceptance of modern system of medicine.
II.
i.
Threats:
Rate of popultion growth as a whole
ii. Illiteracy and cultural beliefs and traditions.
iii. Shifting priorities of the health programmes.
iv. Decreasing private donor resources particularly in rural areas.
v. Lack of commitment on the pan of different political parties to population
control measures.
vi. Lack of professionals commitment to the concept of primary health care.
IG
3^
vii. Medical education still continues to be hospital-oriented.
viii. Values system of the village political leaders and elites towards primary health
care services.
ix. Inadequate communication and transport channels in remote areas.
m.
i.
Strengh:
Clearly defined programme policy, objectives and targets.
ii. Integration of MCH and Family Welfare Programmes.
iii. A large network of primary health centres and sub-centres with required
manpower and facilities for appropriate health care.
iv. Flexibility in the planning process at the local level
v. Development of a system of Health Information and Monitoring and
Evaluation.
IV.
i.
Weaknesses:
Underutilisation of services
ii. Inadequate organisational leadership
iii. Lack of bottom up planning process
iv. Non-availability of functionaries at the place of duty
v. Poor supplies and logistics support
t
vi. Undue thrust to selected few programmes only
vii. Too much target completion orientation
viii. Lack of involvement of the functionaries in the decision making process
ix. Inadequate supervisory practices.
0
17
)
(
Surveillance of communicajite diseases :
Containment
measures and reporting
>
Dr . K. RAVIKUMAR
I
3
>
CHIEF MEDICAL OFFICER
REGIONAL OFFICE FOR HEALTH AND
F.W. .
BANGALORE
Public health surveillance is defined - in it's simplest form - as an on-going,
systematic collection of data for action.
There are 5 steps in implementing the surveillance
1) Collection of data
2) Compilation of data
3) Analysis of data
4) Action
5) Feed back
'.i
In short surveillance is information for action.
Surveillance of common communicable diseases like malaria, AIDS and Dengue
fever have been discussed.
(1) SURVEILLANCE OPERATIONS IN NMEP : The surveillance
operations aim at an efficient case finding mechanism and adequate treatment. There
are two main strategies in surveillance (a) Active surveillance and (b) Passive
surveillance.
'■ i
Active surveillance involves fortnightly visits by the male health worker to each
household and collection of blood smears from all current fever cases and those cases
who had fever since the previous visit. In problematic areas, and where male health
worker posts are vacant, the female health worker also contributes to surveillance.
He will also enquire about any visitors to the house, the place from where they came.
He will ask about the movement history of the members of the family since his previous
visit, these points are necessary to find about the origion of the positive case or its
spread. At the time of taking blood smears it should be ensured that only sterile
Hagedorn needles are used to prevent the spread of AIDS. The blood smears-are to be
sent to the laboratory at the earliest.
Passive surveillance is institutional surveillance whereby all the fever cases attending
the outpatient department are screened by taking blood smears. Malaria clinic is a
specialized form of surveillance whereby in such institutions where laboratory technician
is available and microscope facilities exist, those cases which are clinically strongly
suggestive of malaria are screened for malaria and radical treatment is instituted
immediately.
Fever treatment depots can be set up in those areas which are remote and not easily
accessible. An intelligent person like a Postmaster, school teacher, Anganwadi worker or
a community health guide is taught to take blood smears from fever cases and give
chloroquine tablets as per a prescribed dosage. Drug distribution centers are similar
'I
I
centers where the person is not in a position to take blood smears, but only issues
chloroquine tablets.
i
All the blood smears are examined at the primary health centers by the laboratory
technician and positive cases are given treatment.
Considering the expected number of fever cases in the community, it is targeted to
collect blood smears to the tune of 12% of the population during an year. In passive
surveillance about 15% of the new outpatients may be expected to have fever and so the
same is set as the target for blood smear collection.
Treatment schedule:
(a) Presumptive treatment: Presuming that any fever case can be malaria, at the time of
collection of blood smear, chloroquine is administered to all fever cases as per the
following dosage.
Dosage
Age
y2 tab.(75 mg )
0 - 1 yr.
1 tab.(150 mg)
1 - 4 yr.
2 tab.(300 mg)
4 - 8 yr.
3 tab.(450 mg)
8-14 yr.
14 -and above. 4 tab.(600 mg)
1
3
Chloroquine should always be administered after food only. With this dosage, the
toxicity is minimized. Rarely gastric irritation, nausea, vomiting, headache, pruritus,
blurring of vision etc.
When chloroquine is taken regularly for months as with
chemoprophylaxis for a prolonged period, ocutar damage with neuro-retinitis,
pigmentation of skin may be seen.
(b) Radical Treatment: To achieve a radical cure of vivax malaria, chloroquine alone is
not enough, as the persistent stages of the parasite can cause relapses.
In P.falciparum the gametocytes are not killed by chloroquine.
Therefore
primaquine is also in combination with chloroquine for Radical treatment with the
following schedule.
P.vivax:
I day - chloroquine - 600 mg.
primaquine -
15 mg.
II day
>
to - Only primaquine - 15 mg.
V day
J
P.falciparum:
I day - chloroquine - 600 mg.
primaquine - 45 mg.
II day - chloroquine - 600 mg.
III day - chloroquine- 300 mg
The above dosage are for the adult. In children the daily dose of primaquine is as
follows:
i
AGE
1 - 4 yr.
4-8 ”
8-14 "
14 and above.
DOSAGE
2.5 mg.
5.0 mg.
10.0 mg.
15.0 mg.
Primaquine should not be administered to infants and pregnant woman. When a
pregnant women has malaria, only chloroquine 600 mg is given every week till delivery
and full Radical treatment given after delivery.
The drugs should not be given in empty stomach. Rarely anorexia, nausea, epigastric
distress, abdominal pain etc. may be seen. In those persons with G-6 RD deficience,
primaquine may cause hemolysis which manifests as dark colored urine and cyanosis.
In problematic areas, where large number of cases are encountered, for operational
reasons the radical treatment for vivax cases is curtailed to three days with primaquine
given in doses of 30 mg., 30 mg., and 15 mg.
For all P.falciparum cases, mass and contact survey is to be done. Also the 7th day
follow up smear is to be taken.
To maintain quality control of blood smear examination, 5% of the negative blood
smears are to be sent from all the primary health centers to the Central Malaria laboratory
(3%) and the Regional Health Office laboratory (2%) for cross-checking.
(2) Vector Control Operations: The chief method of vector control in NMEP is by
residual spray operations. In all those PHCs where API during the previous three years
was 2 or above spray operations are to be done. The main insecticide used is DDT. It
should be noted that spray with BHC has been withdrawn. In limited areas where DDT
resistance is proven, Malathion spray is undertaken. The Table-1 gives preparation and
dosage details for the two insecticides.
Each spray team consists of five daily wage laborers and a supervisor for two pumps.
Each pump should cover at least thirty houses in a day.
With increasing problem of mosquitoes developing resistance to the conventional
insecticides, more emphasis is being given for source reduction measures in the form of
managerial problems in the delivery of health services ■
1
>
1.
PR OB LEMS FA CED B Y MEDI CAL OFFICER S
1.1
1.1.1
1.1.2
1.1.3
1.1.4
1.1.5
PLANNING ABSENCE OF MEDIUM AND SHORTTERM PLANS
LACK OF LABORATORY FACILITIES
SLASHING OF MEDICAL INDENT
NON-A VAILABILITY OF MEDICINES
INADEQUATE FOLLOW -UP OF PATENTS
1.2
1.22.
1.23
1.2.4
ORGANISING
SHORTAGE OF EQUIPMENTS
. LACK OF PHYSICAL FACTLITES
INADEQUATE DELEGATION OF POWER
13
13.1
1.3.2
133
13.4
1.3.5
1.3.6
STAFFING
SHORTAGE OF DOCTORS
SHORTAGE OF PEONS
LACK OF TRAINING ■
UNA TIRA CT VE TERMS AND CONDITIONS
LA CK C h' PR OM OT ONAL A VENUES
INADEQUATE FRINGE BENEFITS
1.4
directing
1.4.1
REFUSAL OF DOCTORS TO TAKE RESPONSIBILITY
1.4.2
INTERFERENCE OF CLASS III & IV UNION
NON INVOLVEMENT IN TRANSFER OF STAFF
1.4.3
)
L5
1.5.1
1.5.2
1.6
1.6.1
COORDINATING
lack of coordination between various segments
ATTITUDE OFI.PS
1.6.2
REPORTING
UNTRAINED STAFF
MORE CLERICAL WORK FOR DOCTORS
1.6.3
DUPLICATING OF WORIC
1.7
1.7.1
1.7:2
1.73
BUDGETING
inadequate financial powers
1.8
PROBLEMS IN RELATION OF ADEQUATE UTILISATION OF PROFESSIONAL SKILL
NON-INVOLVEMENT
INS UFFI CIENT IMPREST MONEY
'2.
2.1
2:2
7
IJIVS/ANMS/D/\IS
PHARMACIS'FS
^3^
2.3
2.4
laborator y technicians
dressers
3.
PROBLEMS FACED BY ADMINISTRATORS
3.1
3.2
3.3
3.5
3.6
3.7
3-8.
3.9
3.10
INSUFFICIENT DELEGATION OF AUTHORITY
INADEQUA7EADMINlS'mATlVESET-UP
NON-AVAILABILITY OF STAl-F
ALLOCATION OF DISPENSARY TO I.PS.
PROCUREMENTOF MEDICINES
DIS'IRIBUTION of medicines
PILFERAGE OF MEDICINES
LAX-CERTIFICATION
FINANCE
SON-AVAILABILITY OF LAND
4.
problems faced by patients
4.1
LOCATION
WORKING HOURS OF STORE
LONG WAITING TIME
AMENITIES
ARRANGEMENTS FOR E3CAMINAT1ON IN PRIVACY
TIME DEVOTED BY DOCTORS
ATTITUDE AND BEHAVIOUR OF DOCTORS
AVAILABILITY OF MEDICINES
DOM’CILIARYVISITS
REIMBURSEMENTFACILITY
REDRESSAL OF GRIEVANCES
3.4
4.2
4.3
4.4
4J
4.6
4.7
4.3
4.9
4.10
4.11
I
PROBLEMS FACED BY PATIENTS AT REFERR AL CENTRE (HOSPITAL)
3.
5.1
5.2
5.3
5.4
5.5
5.6
5.7
5.3
5.9
LOCATION OF HOSPIW.
INADEQUATE AMBULANCE SER VICES
WORKING HOURS OF O.l’.D.
OVER CROWDING
ATTITUDE AND BEHAVIOUR OFDOCTORS/STAF.F
WAITING TIME
TIME DEVOTED BY DOCTOR
PROCEDURE OF ISSUE OF MEDICINES
ADMISSION IN HOSPITAL
I
I
I
I
I
B'oenvironmental control measure
Urban Malaria Scheme- Onlv n
a
•
ZoZaZ:TUreS “Zr*ZZoZZZ" in ,te
«=. are u„d.nake,„/
»*«■ *=* «e„ .tc. e Wotegica““r“ tTSroS
—ationaia,dscontrolprogramme
Surveillance
JpleSne^ “egarSg “fe diSS""0'09'"'
accuracy and <
•nfect!on relevant to the
Programme.
’ p'an”9
«
spread of HIV
is
-..j control
'! f
‘■e“,ssl"'<Xtte0t>iect|Ves„fSu„ei|anee
1) General Objectives :
T° establish AIDS
CaSe""',ita"'n’»««ical,„st#u,i0„softhe
2) Specific Objectives •
country.
3)J° ,mProve identificatio
n of AIDS cases among persons
and reporting.
approaching for medical aid
b) to establish a i '
referral system for suspect AIDS cases
encourage
oura9e studies
SMes
3
»»
sensitivity and
specify of the clinical AIDS case
Types of Surveillance :
sectional studies (also knowmOn,t°r trends in mv infection over
Population and also reoeated
preva,ence studies) have to
population r* groups in the population
............
departmentand time. cross
population, they are known a « -Sentinel9rOups.
>a5
Sexua||y
sentinel surveillance.
undertaken among
separated cross sectional
surveillance can be r—community based or clinic based. It can be
groups like Commercial r;
—I sex workers
or low risk groups
'"'/n among such low risk
groups show
prevalence in
Type of Testing :
4 klnds °f testing strategies
are possible
,1LMuandatory TestinS •' Not r• ■
P,S'“f fOr ,eai"S
and blood products,
• organs or tissues.
■H'
Pisons. But (or scree„lng 0, WoM
2) Un linked anonymous Testing • a
Purposes is tested for HIV after all't^ STTiPle °f b,00d ori9inally collected
Wood sample are eliminated from the X'nf°rmation that ooulcI identify the - for other
Th-s is the method of choice.
SamPleMinimal participatln bias
source of the
--J results .
3) Linked anonymous • /
An individual agrees to have a HIV test. The sThe siample is given a
are removed. The individual has the
•J code and can
“M"y
(confidentiality is most
X*XaSed°peTe„r H'V
known only to
His or her
essential)
Institutions involved ;
oZXX <ASC)- *
pateoon. “7'l"an" “ ""‘'“'‘•P
^yXXV^ratfon
case
a" lh. Heeith ,„stiMo„s
V Non-referral Institutions ■
• They can onty identity suspect A,DS csses
Provisional diagnosis of such
• i case.
Kf.:
- - - ...... -ksssxkxSx-
Activities :
Both Non-referral and referral institutions will carry out the following functions :
1.Identify patients suspected for AIDS according to WHO AIDS clinical case definition.
2. Cany out examination by available techniques.in order negate or reconfirm " suspect
3. Refer the suspect cases to nearest referral hospital
4. Follow up the confirmed cases for treatment, counseling and home care.
5. Report on the surveillance activities.
j
i he referral hospitals include the following additional activities :
6. Conduct detailed clinical and laboratory examinations to confirm the diagnosis. The
PRAM may have to pay visits to the peripheral healths institutions
7. Provide necessary temporary hospital care to the patient
8. Prepare recommendations for treatment, home care and follow up of aids oatients
through the original medical institutions.
P
)
>
9. Arrange for training and supervisory visits to the institutions within the catchment area
of the referral hospital.
10. receive, compile and submit reports.
Activities of the AIDS case surveillance Co-ordinator at the referral Hospital :
1) Co-ordinating with the Medical Superintendent/District Surgeon of the hospital and
state ASC in the establishment of the surveillance network in the surveillance activities.
2) Training of medical staff at his own hospital and also medical staff of all health
institutions in the area.
3) In case the testing facilities are not available at the hospital where he is working, he is
the only authorized person to send blood samples for HIV testing.
4) Arranging for hospitalization, diagnosis and treatmeht of suspect AID case referred
from other institutions.
5) Counseling of cases in the Hospital and developing the counseling services for case
in the area.'
6) Supervision of the activities in peripheral institutions
. "
7) Monitoring the reporting system.
3
Dengue surveillance :
>
In practice, the surveillance of Dengue & Dengue Haemmorhagic Fever(DHF)
means collection of data relevant to the occurrence of these illnesses in order to take
action to prevent or control them, so that, it no longer would be a public health problem.
It should permit immediate actions to prevent or control an epidemic of dengue. The
system should be simple in its structure and operation, representative of the population it
serves, acceptable to the users, flexible to allow the incorporation of new information, and
opportune in data collection and analysis. The system should have adequate sensitivity
and specificity to correctly identify those individuals with the disease and efficiently
exclude those without it.
The surveillance system should have both the clinical and entomological
perspectives. As DF can be clinically impossible to differentiate from other febrile
illnesses, the surveillance must be laboratory based.
Surveillance for Dengue can be either active or passive. The concept of active and
passive surveillance differs from that in malaria.
Passive ( Reactive surveillance):
This requires case reports from all health institutions including those in the private
sector regarding dengue like illness. Here, the health authorities wait until transmission is
recognized by the medical services and detected through the reporting system. Currently
DF/DHF is not a notifiable disease. If the passive surveillance system is to succeed in
defining trends in dengue transmission, and detect any increase in incidence, the
DF/DHF should be made notifiable. This statutory mandate is required for establishing a
nationwide surveillance system. Even so, there can be significant under-reporting and
poor sensitivity in view of the level of suspicion among medical professionals being low
regarding diagnosis of DF/DHF in periods of low transmission. Many patients with milder
forms of the illness may not seek medical treatment. Therefore dependance only on the
passive system may result in delays in implementation of prevention oriented action.
Active surveillance :
The objective of an active, laboratory based surveillance system is to generate
early and precise information on four aspects of increase dengue activity : time, location,
virus serotype, and disease severity. Therefore it should be pro-active, in the sense that,
it should allow for early detection of dengue cases, improving the capacity of health
officials to prevent and control the spread of dengue. The emphasis in active surveillance
is on the predictive capability. Analysis of trends of reported cases, the establishment of
sentinel clinics, laboratory confirmation suspected, dengue cases qnd the rapid
identification of the serotype involved in transmission, provide the necessary information
to predict dengue transmission and guide implementation of control measures well in
advance of peak transmission period.
In India, the National Institute of Virology with it’s field stations and the National
Institute of Communicable Diseases have already established a system of testing blood
samples for dengue. In addition there are other institutions like medical colleges who also
do dengue diagnostic work. Proactive clinical surveillance must be linked to
entomological surveillance.
There are vast areas in the country where dengue has not been reported, but
which are infested with Aedes aegypti and Aedes albopictus. Except for reports from a
1
•>
)
few rural locations, the disease has been reported mainly in the metropolitan areas and
other urban areas. However, in all these areas, the risk of major dengue or dengue
haemorrhagic fever epidemic exists for much of the population of India. In such areas,
dengue surveillance should rely on searching for, and investigating, clusters of
nonspecific febrile illness by a fever alert. In a fever alert system, trends in rates of
febrile illnesses are monitored as an early indicator of possible dengue activity during
periods of low level transmission.
Dengue is endemic in a majority of the towns in India. In these places, very few
blood samples are sent to the laboratory for dengue testing during the interepidemic
periods because of little case identification. At least one major hospital in all the towns
should be identified as the sentinel clinics. Criteria for taking blood samples must be
expanded to include febrile cases with history of recent travel, and situations where
dengue might be causing clusters of fever cases with rash. These hospitals must also
maintain communication with the private hospitals/practitioners.
3
Serological surveys
Community serosun/eys, done during and after epidemics define the true
incidence of dengue in the population by age, sex, and geographic location. Such
surveys provide opportunities to characterize the epidemic, define the populations at
highest risk, and identify risk factors for infection. The population based data also can be
used to examine the accuracy of the surveillance system, effectiveness of control
methods, the cost of the epidemic, and the immune status of the population. They can
also be used for descriptive or analytical purposes. Such surveys will use a combination
of respondent interviews with blood sampling to provide information on symptoms and
the progression of the illness through the community. Blood samples can be collected by
finger prick method on filter papers. To measure accurately, the rate of infection in a
community, respondents must be bled at least twice( at the beginning and end of
epidemic transmission) to test for IgG seroconversion, or sequentially every month to
detect all the IgM positive cases. ~
,
■
3
^'3
There are several tests that can be used for routine serologic diagnosis of dengue
viruses, including the hemagglutination-inhibition (HI), the complement fixation (CF), the
plaque reduction neutralization (N), the IgM-capture ELISA tests and dot blot tests (IgG,
Ig?«/1). Of all these tests, the MAC ELISA, generally requires only one sample and is a
simple, quick test that requires very little sophisticated equipment. Therefore the
laboratories should perform IgM capture ELISA test initially to provide rapid results. Virus
isolation by inoculation of the C6/36 mosquito cell line is a relatively rapid, sensitive, and
economical method that can be set up in most general laboratories. The reference
laboratories should be equipped to identify the type of virus which will give an indication
of the severity of cases.
■ ’ n/7 k, a
MALARIA - RECENT TRENDS IN PREVENTION7^7
1
AMDCONTROL,
.
i
Dr .K. RAVIKUMAR
CHIEF MEDICAL OFFICER
REGIONAL OFFICE FOR HEALTH AND
F.W.
BANGALORE
1
Epidemiological features
Malaria is one of the major communicable diseases
that has
been associated with mankind since time immemorial.
£
exactly 100 years back, that the
person to another hv ns was discovered
x
, to be transmitted
Lran^rnirted from one
anopheli
r.P.on a Id
. . ..Ross
/ it,
mosquito,
o ...
” of
—■ infected anopheline
mosqHjto by Sir
a hrj.t.ish doctor working
•
in
Indian
Army
Medical service
at a place not. very far away from here.
/ ie. at Secunderabad.
-as .. ,.
3
J
pri or
malaria control
were
army contonrnent
>/ source reduction measures aimed at mosquito
control.
The National Malaria eradication p-------programme launched in 1958 in
our country is one of the biggest public
health
------- 1 programmes that are
in existance.
Af ter the dramatic decline
in incidence of malaria seen in the
Sixtees, there was resurgence in malaria in
---------most part of the ccountry.
The disease was at it:s peak around
1976
which
r
—
------1 necessitated
radical
chances in the NMEP giving rise to the Modified
Plan
of
Operation,
This ' was again followed by very significant
decline in jnalaria
incidence all over the country.
From 198 3 or.wards, the
total malaria .cases in the country was
around two million per annum,
touching the lowest incidence of 1.66
million in 1987 a nd tthe
’
peak of 2.51_ raillion
------- in 1993. The proportion
o.t P.f. showed gradual
and consistant increase from
34.5% in 1995 with the peak reaching 43.35% in 1991. 9.73% in 1977 to
Af t or la ij n ching o f mm £ p t the deaths due 1
1
to malaria
were first
recorded during 1974 and the peak 1122 deaths reached
in 1994
due
to
1
in
1994
due ’to
epidemics in Pajastan , r
I
an.ipur,
and
Nagaland.
The
deaths
recorded
due
to malaria were a.l.so highi reach.i
reach.! fig
r,g the figure of 1012 during 1995.
During the year 1997, about 1.8 lakh cases have been
reported in
the stale. 'Clip annuril
annua I blood
examination rate in karnataka is J.7 which
L s one of Cho hiahpst
hinh^st among t
the different states of the country. Th*--*
AP .1. for the .-ilat.Q
:) <1^
,
.■■ilatn ii.u
hPR io 2.39. The SFR wao 0.64. Though
- rt r'<i
r'. | t r,»in .nil.
^laria is rop.
rnport
the districts,
only few districts
-->■ are
problematic. Districts of Bijapur, Raiochur, Mandya, Kolar, and
Bellaxy
are the most problematic which together have contributed
68.2% of malaria incidence.
A study conducted by MRC-ICMR New Delhi has shown that about
190 million cases are being prevented annually in the country due
to the malaria control activities. Approximately Rs.76,660 million
are being saved every year due to malaria control operations now
being implemented in the country. The total expenditure incurred on
malaria control in India is around Rs.3468 million. Thus every rupee
invested on malaria control has produced a direct return of
Rs.22.10.
The estimates of labour clays saved come to 1328.75 million mandays per year.
The expenditure per capita per annum being incurred by G.O.I
(NMEP) and other organizations works out to Rs. 3.85. To this must
be added the expenditure incurred by general community on the
treatment of malaria cases. On the basis of MRC estimates of 25
million cases per annum (ten times the incidence recorded by NMEP),
the expenditure per capita per annum works out to Rs. 3.33 . Thus
the total expenditure incurred on morbidity due to malaria works out
to be Rs. 7.18 per capita per annum.
Malaria is a local and focal disease. Accordingly no uniform
control strategy can be adopted in all the areas. Efforts have
always been made in the programme to undertake area specific control
strategies. When MPO was launched, the areas were classified into
those with API more than two and those less than two for specific
control measures.
The indepth
evaluation
studies
that
are
periodically conducted have stressed that stratification of areas
has to- be done.
A malar!ogenic stratification process has been undertaken in
Karnataka
taking into consideration topography, rainfafl, vector •
prevalance, API, epidemic potential, and vulnerability. The Primary
Helth Centres were stratified into strata I ’to V with I being least
problematic and V being the most problematic.
However application of the malariogenic stratification to other
areas in the country has not yielded desired results because some
of
the weiqhtages
assigned
weighteyjes
to
parameters
require
further
modification and field testing.
As per the Malaria /xction Plan 95, newq criteria are being
applied for identification of problematic PHC's ( High risk PHC's)
based on the SPR and P.f % which are relatively more sensitive and
specific indicators. The following are the criteria :
I.
Doubling of SPR during last three years provided the SPR
in second and third year reaches 4% or more.
Wh.-* |•.•p
th r
such doubling is not seen but averagf3 SPR of last
years is 5% or more.
t
3.
P.f proportion is 30% or more, provided SPB is 3%
or more
during any of last three years.
•»
About 178 PHC's have been identified as High Risk PHC's out of
the current about 1400 PHC's in the state.
Residual insecticidal spray :
1
J
■’pravCTthtDm-ally- fDT haS been thS ’nain in3ecticide used for
malari- n^M
rGslstance securing as a widespread phenomenon, and
malaria problem increasing in many areas, alternate insecicides are
being sought after. BHC is being phased out and use of Malathion has
z\enewVery llnXited because of P°or acceptance and resistance problem.
a new group of compounds namely synthetic pyrethroids have been
introduced into the program. In Karnataka a trial was taken up with
Lambdacyhalothrin in two selected PHC's for about three years which
nd
M1,3V,'n tO bG remarkably effective. Currently, Deltamethrj n
district- Th"
9 USed 10 Hassan' Chickamagalore and Tumkur
uistrlct^. These have proven to be extremely effective and safe.
Bio-environmentai control measures
>
:
Residual insecticidal spray cannot be the only vector control
measure because of the inevitable resistance problem and the cost
trials done in many parts of the country by
uKC have conclusively proved the effectiveness of the
Bioenvironrnental control measures. In Karnataka, 1 '
'
the field station of
MRC has worked in the Kolar, Chickatnagalore and Hassan districts
•-lemonstrate the methodology cnnd train the personnel, The mainstay of
this method is detailed Geographical Reconnaisance of all the
breeding places and planning suitable larval control measures for
each variety of the breeding place. The different methods
methods-■are :
1) Source reduction measures
3
2)k Use of larvivorous fishes
3i Use of Biocides namely Bacillus thurigensis and Bacillus
sphaericus
Use of expanded Polysterene beads
>
Impregnated Bednets :
parts of
of the
the country,
country, use of bednets impregnated
vith In
" different parts
vith synthetic pyrethroids have been shown to be very useful.
Malsiria. Vaccine
:
The development of an effective malaria vaccine represents one
ty- most important strategies for providing a cost-effective
addition to current.I.y available malaria control interventions. To
I
date, relatively .few malaria vaccine candidates have progressed to
clinical and .field trials. Much of the research activity over the
past 15 years has focussed on the identification of unmodified
parasite antigens to be formulated in traditional
------------------ adjuvants such as
alum. This is now changing as new pperspectives to producing modified
antigens are developed, together with new strategies such as DNA.
vaccines and novel adjuvants for humani use. In addition, considerable
experience has been accumulated in the• design and execution of
clinical and field trials for malaria •vaccines.
Drug Resistance
:
resisiit’Trr3 °£ ti3 CTtr^ different levels of chloroquine
resistant P. falciparum have been encountered. In Karnataka also, in
tne districts of Kolar, Gulberga, Bijapur, Raichur, Hassan,
Cmtradurga and Chickamagalore many foci of such resistance have been
seen. However, still there is no indication for change in the drug
Chemotherapy :
In all the High risk areas, with a 'view
'
to reducing the
parasite load in the community at the earliest and thereby
interrupting the transmission, changes have been instituted
in the
presumptive treatment by introducing primaquine alongI with
chloroquine.
Quinine has remained the drug of choice in the treatment of
complicated forms of malaria like cerebral malaria. A new group of
group
compounds namely Artemesinine have appeared in the market. While
these are yet to be adapted by the NMEP,
, care has to be taken by the
physicians in use of the same.
The need- of the hour is to undertake an
intergrated vector
.control strategy. Dependence only on insecticidal
--------- spray cannot
remain as
as the
the intervention measure.
Increasing stress on
Bioenvironmental control measures is requested.
Apart from malaria, these are various other
communicable
diseases
transimitted
by
mosquito
namely
Dengue
namely
Dengue
fiver,
Fxlariasjs,
Japanese
encephalitis
etc.
whch are
etc.
whch
are
becoming
increasingly problematic. There fore
source reduction measures
aimed at oreventing rnosguito breeding
are a priority. Though for
a medical man, the clisesase transmitted by the mosquitoes are
importont for the common man, it is rather the mosquito nuisance
that is the control of mosquito nuisance,
A brouder strategy
aimed at mosquito control is required.
No public healths programme is complete without active
community participation . In this respect it has been admitted
that the requirnd lovel of
community participates has not been
<r
3^
t
*)
1
I
forth comminq in the
Programme. The aim or the malaria
to create awiireness r
month in
the community regarding
dspects of malaria the different
C°ntro1'
desired participation is^cheive^.
’ so that the
Similarly the private medical r
■■■■
P-tecti
|GdiCine haVS been involved ••
‘ ti oners of different
J
'in
the
not lay emphasis on th^ micr^o^.^ •
programme. They do
complete radical treatment o/
dia9nosis of malaria
handy ol the private medical malaria. As theJ public
Public is
is in
in the
practioners, it is OLlr
our dutv m
communicate to all these
practitioners
rer'
*
garding the different
aspects of the NMPJP.
nnT7 P.s OR MKOICAI. OPb'TCER,
PRIMARY HRAI/-•] |
^JI'rpR ;
GENERAT,:
The Medical Officers of Primary Health
Centre will divide
the area amongst themselves on a
geographical basis and will be
responsible for all the activities under
Health and family WeiEare
3
Programmes in their respective areas.
However, ultimate responsi-
bility
Will lie with Medical Officer Inchargc,
PHC/Block M.O.
who will be. in addition.
administrative head of the Primary
Health Centre.
Block M.O./M.O., IC/PHC is responsible for
3
implementing all
activities grouped under Health and
Fam i 1 y We 1 f a re delivery system
in PHC area.
He is responsible in his individual <
capacity, as
well as overall incharge.
It is not possible to enumerate all
his tasks. however, by virtue of his designation,
it is implied
that he will be solely responsible for the
proper functioning of
the PHC.
He may assign any job to any health
functionary in his
team, which is deemed essential by him towards achieving National
Health goals.
I. CURATIVE WORK*
1.
The Medical Officer will organise the
dispensary, out-patient
department and will allot duties to the
ancillary staff to 'ensure
smooth running of the OPD.
3
2.
He will make suitable arrangements for the distribution of work
in the treatment of
emergency cases which come outside the normal
OPD hours.
He will organise, laboratory services
for cases where necessary
and within the scope of his laboratory for
proper diagnosis of
doubtful cases.
3.
4.
He will make arrangements for rendering
services for the treatment of minor ailments at community level,
at the PHC and Hub-Centre
level throuqh the Health Assistants and others.
5.
He will att-’nl to cases referred to him by bealt!, Assistants,
Health Workers, Health Guides, Dais or by the School Teachers.
He will screen cases needing specialise I
me' I leal attention
including dental care and nursing care and refer
them to referral
insti mt ions.
2
2
7. He will provide guidance to the Health Aurjisi .mi-.s. Health
Guides and School Teachers in the treatment of minor ailments.
8. He will cooperate and/or coordinate with other institutions
providing medical care services in his area.
9. He will visit each subcentre in his area at least once in a
fortnight on a fixed day not only to check the work of the staff
but also to provide curative services.
II . PREVHHTTVE AMD PROMOTIVE WORK:
He will ensure that all the members of his Health Team
are fully conversant with the various National Health and Family
Welfare Programmes to be implemented in the area allotted to each
health functionary.
He will further supervise their work periodi
cally both in the clinics and in the community setting to give
them the necessary guidance and directions.
He will prepare operational plans and ensure effective
implementation of the same to achieve the laid-down targets/
estimates and community needs assessment, under different National
Health and Family Welfare Programme. (RCH).
He willikeep close liaison with the Taluk Medical Officer
■and other Officers of Taluk level and his staff, community leaders
and various social welfare agencies in his area and involve them
to the best adveritage in the promotion of health programmes in
the area.
Wherever possible, he will conduct field investigations
to delineate local health problems for planning changes in the
strategy of the effective delivery of Health and F.W.Services(RCH).
1, R.C.H. Programme:
1.1 He will provide leadership to his tern in the implementation
of RCH Programme in the PHC catchment area and PHC should
function as a centre of FW & RCH movement.
1.2 He will be responsible for proper and r.iicc'-’S.':(u.1 implemen
tation of RCH Including FW Programme•in PHC area, including
education, motivation, delivery of services and after care.
1.3 He will be sguarely responsible for gi.virw immediate and
sustained attention to any complications the acceptor develops
due to acceptance of Family Welfare methods and other services
under RCH Programme.
. . .3...
3
3
3
t
1.4 He will extend motivational advice to all eligible patients
he sees in the OPD.
1.5 He will get himself trained in tubectomy, wherever possible.
and organise tubectomy camps.
1.6 He will organise and conduct No scalpel vasectomy camps.
1'7 and^h SeSk hS1P frOm Dist.Health & Family Welfare Officer
and other agencies such as other associations/Voluntary
Organisations for tubectomy/lUD camps and MTP services.
1.8 He will ensure adequate supplies of equipment, drugs, educa
tional material and contraceptives required for the services/
programmes.
1.9 He will provide leadership.and guidance for special programmes
such as Family Welfare and Immunisation, STD awareness campaign
under RCH, festivals and fairs.
1.10 He will organise regular staff meetings to rovi-w th- progress
made and to discuss the problems and future plans.
1'Ue^iS
to train himself in communication techniques
so that he can provide leadership and guidance to educational
and motivational group talks to eligible couples/cornmunity .
!.12 He will develop and maintain cooperative work-relationship
with other agencies and opinion leaders'
in th- PH~ in
order to generate and sustain Family Welfare as a movement.
1.13 He should encourage and ■_
... give all help and assistance
to private medical practitioners and practitioners of ISM in
the implementation of Family Welfare and RCH Programme.
1.14 He will ensure proper and up-to-date maintenance of EC registers
through spot checking.
1.15 He will ensure that the block’ level committee and other
committees in catchment area are properly constituted and
made operable under the guidance of Taluk level Medical Officer
1.16 He will provide
MCH services such aas antenaLa 1, i ntranatal,
and postnatal care of mothers and infants3 and child care
through clinics at the PHC and subcenters.
>
1.17 He will make estimate of community
<--need assessment of MCH
services, immunisation services,, new born and child care services
and also awarness and medical r*
care of XTFO RTI / AIDS for his
area on the basis of community need1 assessment done at subcentre
area by Health Assistant Male & Female and also for entire’
PH_ area and prepare an action plan for providirn other services.
1.18.He will actively involve his health team in the effective
implementation of the Nutrition Programme and administration
of Vitamin ’A* and Iron & Folic Acid tablets.
1.19 He will plan and implement UIP Immunisation services in line
with the latest policy and ensure maximum possible coverage of
the estimated beneficiaries in the PHC area.
1.20 He will ensure adequate supplies of vaccines and miscellaneous
of Tmmun?U1t° fpOm h1'"® tO timS f°r th”
implementation
or Immunisation Programme.
1.21 He will ensure proper storage of vac-in^s an*! maintenance of
cold-chain equipment.
>
1-22 He will arrange for surveillance and reportinn of valine
preventable diseases in his PHC area through th- pho sra'ff on
confirmation of the same by investioatim hims-lf
. . A . .
4
MATIONAI, ma.i,?rla
) lca i'tor1
i
’ f V-;:
He is the kingpin in ear.Lv case Hotr.ci j on ,iri I prompt
treatment: mechanism in rural a re a s.
He should be well trained
and take keen interest in this activity.
■ro
fulfill the duties
under the Primary Health Care System, he should carry out the
following activities:-
1 . He will, in consultation with District
Malaria Officer
and the community, select FTD/DDC holders arrl
Voluntary Link
Workers for his PHC.
2. He will also select headquarters of DDCs,
^ros. and
Voluntary Link Workers.
3. He will make a fortnightly calen lar for house-to-house
visit of MPW (Male) in consultation with OHO.
4. He will refer all fever
cases to malaria laboratory.
5. He will supervise all Malaria Clinics and PHC
la^oratory
in his area, see the guality of blood smear collection,
staining,
efficiency of microscopic examination and check wIiefl’iQr
the stain
is filtered daily.
6. He will ensure that the Laboratory Technicians
maintain
Mr-7, 8 and 9 registers and also other charts and
raphs showing
subcentre-wise and passive agency-wise blood smear collection.
examination and positive cases.
7. He will also ensure/supervise
that all positive cases
get radical treatment within 48 hours of examination.
A. He will also ensure that-sufficient stocks of antimalarials
including Quinine tablets and injectable buinino are available
in PHC
and per i phery.
9. He will, while supervising the
malaria 1 aboral-ory (eitf^er
at PHC or at Malaria Clinic) look into the
corrfjtion of microscope
and other equipment. stains, glass slides. etc.
lO.’.-'hile on tour, he will verify that-MPW (Male)
ar»d Mr*’-!
(Pemale) carryout malaria case detection as
Lai 1 down in this manual.
11 . He will do data analysis for action
and f .'Fe-'l i ct ion of
outbreak and also assist in enidemiolooica1 invest i. oa t i on.
12. '•’a v/ill provide referral services
ma1ar i a.
I
(
.
!■ ■I > i ! . < I
i I
III/.
1 r '
r
r»ov'-'re
11 ci -fit
I
’n 1
comri
i I II i
cases of
. i
I . • »I
i
• ill
■»
) J r.'
. I
1 1 ‘ :/ -l ic.
30
5
14. He should monitor the drug failure in malaria
cases
(failure of response to Chloroquine) and inform
the District
and State Head Quarters immediately.
15. He will ensure that records of clinically diagnosed
cases are maintained.
16.
He will ensure that the spray operations
are conducted
as per schedule and in case of any delay, he will find
out the
reasons and reschedule the programme with approval of DMO/DH & FWO.
17.
1
He will solve any bottlenecks in spray operations in
his area such as turnover of seasonal
spray men (field workers),
insecticide supplies, shifting of camps. e tc.
18. He will see that reports are sent in time.
19. He will contact DM0 immediately in case of delay/
suspension of spray programme and solve tlie
problems.
20. He will, during filed visits,
inspect spray operations
atleast once a week.
CONTROL OP COMMUNICABLE: DISEASES: •
1. He will ensure that all the steps are heinq taken for
the control of communicable diseases and for the
proper maintenance
osanitation in the villages.
2. He will take the necessary action in case of
any outbreak
of epidemic :.n his area.
>
3. He is responsible for inspection
of all drinkinq water
sources in each village in his PHC area and take
measures for
disinfection periodically.
4 . He will identify immediately
the accurance of epidemic
diseases in his rarea
after confirming himself xrcDnxdxxXKiyx and
>
intimate to the Taluka Magistrate, Taluka Medical Officer and
District Health and Family Welfare Officer and also take
necessary
arrangements for KEJHkxHmaKX containment measures with the assistance
from the community. Grama Panchayat, and 'other departments and
will send the report of action taken as per guidelines and
norms
of the department.
. .6. .
)
6
LEPROSY:
1. He will provide facilities for early detection o! cases
of Leprosy and confirmation of their diagnosis and treatment.
2. He will ensure that all cases of Leprosy take regular and
complete treatment.
TURERCUhOSI3:
1. He will provide facilities for early detection of cases
of Tuberculosis, confirmation of tlieir diagnosis and treatment.
2. He will ensure that all cases oE Tuberculosis take
regular and complete treatment.
SEXUALLY TRANSMITTED DISEASES:
1. He will ensure that all tlie cases of STD/AIDS are
diagnosed and properly treated and their contacts are traced for
early detection.
2<> He will provide facilities for VDRL test Eor all
pregnant women at the PHC.
3. He will arrange awarness campaign on STD/AIDS by exten
sive IEC Activities and conducting group meeting in the special
context and also provide medical care to the cases including the
referral if needed. He will also provide medical services to
the women suffering from RTI at subc^ntre level and PHC level
including referral if necessary.
SCHOOL HEALTH:
1. He will visit schools ±n the PHC area at regular inter
vals and arrange for medical check-ups, immunisation and treatment
with proper followup of those students found to have defects.
NATIONAL PROGRAMME FOR PREVENTION OR VISUAL IMPAIRMENT AMD CONTROL
OF RLIHDHESS:
1. He will make arrangements for rendering:
a) treatment for minor eye ailments and
b) testing of vision.
2. He will refer cases to the appropriate institutes for
specialised treatment.
3. He will extend support to mobile eye-care units.
4U
He will organise cataract eye orx-?ra t lori camos in his
PHC area in consultation with the District Mobile Team bv
1 nvo I v i r i'i Vr> I untary Organ i sa t i ons, I’anclt.i-'i • s H I >' I oi I ,.>r .';oc i. a 1
workers.
. .7. .
3
: 7
He will also takeup the followup of the
eye camp bene fl
claries for any adversory reactions/effects
atter each eye-camp
and report any to the DH & fv/O.
DIARRHOEAL dissasrs CONTROL PROGRAMME:
1. He will ensure through his health
team early detection
°F diarrhoea and dehydration.
<
2. He will rarrange for correction of moderate
and severe
dehydration through
i appropriate orl/parental fluid therapy.
3. He will arrange for availability of
ORS pockets in
each village in his area by opening ORS Depots
and maintain the
list of such depots number of beneficiaries,
No.of pockets distributed to the depots by health assistants.
NUTRITION:
lOgiME DEFICIENCY DISORDERS: He will takeup
for consumption of iodised Salt and also
of salt samples for analysis of iodine
measureso
awareness procrramme
arrange for collection
content and take appropriate
TRAINING;
1. He will organise training programme
includingcontinuing
education with the assistance of his staff
And under the guidance
oC the District health authorities arid Hen I tli and
••'W Training
Centres under the MPW Scheme and School Health
Services Schemes.
2. He will educate the community as
as to the selection of
Health Guides and will take
take the
the necessary steps to train the
Health Guides from his area.
l
3. He will also make arrangements/provide
assistance to
the Sr.Health Assistant Female and Jr.Health Assistant
female
in organizing training programmes for indigenous
Dais practising
in the area.
>
ADMIN I GT,7 ATI VR WORK:
1. He will supervise the work of stair wnrlir„, nnd-r him.
2. He will ensure general cleanliness inside and outside
J
the promises of the rue and also proper maintenance of all the
eguipmont under his charge.
3. He will ensure to keep up—to—date
inventorv and s t oc k
register of al 1 the stores and eguipment .ri»ipp| p»ri
to h.im and
will be responsible for its correct accountino.
p
8
4. He will get indents prepared timely Lor Irugs, instruments,
linen, vaccines, ORS and contraceptives etc. sufficiently in
advance and will- submit them to the appropriate health authorities.
5. He will check the proper maintenance of the transport
given in his charge.
6. He will scrutinize the programmes of his staff and
suggest changes if necessary to suit the priori.tv of work.
7. He will get prepared and display charts in his own room
to explain clearly the geographical area, location of peripheral
health units, morbidity and mortality, health statistics and
other important information about his area.
8. He will hold monthly staff meetinns with his own staff
with a view to evaluating the progress of work and sugnesting
steps to be taken for further improvements.
' 9. He will ensure the regular supply of medicines and
disbursement of honorarium to Health Guides.
10. He will ensure the maintenance of the pr-u/.cr i bed records
at PHC level.
11. He will receive reports from the mrlphery, got them
compiled and submit them regularly to the district health authorities.
12. He will keep notes of his visits to the area and submit
every month his tour report to the CMO.
13. He will discharge all the financial dutd.es entrusted to
him.
14. He will discharge the day-to-day administrative functions
pertaining to thie PHC.
15. Any other work entrusted, by superior officers from
District or State level.
I-E.C. ACTIVITIES:
1. He will be responsible for organising IEC Activities
for creation of awarness on various health problems of the area
and various health programmes implemented to improve the health of
the community by organising group meetings, distribution of IEC
materials, conducting of film shows and interpersona1 contacts etc.
2. He will ensure that proper accounting .u:-1 ut i l isa I. ion of
health education materials and maintenance ot the ecuipnnnts.
I
' ' C> • / - ' /
sUVNOTIFICATION OF DISEASES
Usually
serious
menaces
to
are
which
public
considered
health
"Notifiable Diseases".
of
list
diseases
are
included
to
be
in
the
Notification system is
usually operative through certain legal acts.
Mysore Public Health Act 1944(1-2-1944)
As
this Act
per
Sect ion
the
63
diseases
notified
are:
1. C.S.F.
7. Plague
2. Chicken Pox
8. Rabies
3. Cholera
9. Scarlet Fever
4. Diphtheria.
10. Small Pox
5. Leprosy.
11. Typhus
6. Measeles.
or any other disease which the Government may from time
to time by notification declare to be notified disease
for
of
purpose
the
State
the
throughout
part
this
or
as
may
generally
either
in
the
diseases
are
specified
be
Notification.
(This Act has not yet amended)
International
the
At
to
notifiable
Geneva
in
WHO
level
the
under
International
the
Health Regulations(I HR)
viz - Cholera, Plague,Yellow Fever.
A few others
/
Louse-borue, Typhus^ Relapsing fever.
Polio, Influenza, Malaria, Rabies
to
subject
are
Salmonellosis
International Surveillance.
Although
1imitat ions,
the
Notification
still
it
provides
early
warning
about
new
certain
information
valuable
about fluctuations in disease frequency.
provides
from
suffers
It also
occurrences
or
extended
to
outbreaks of diseaes.
The
>
many
concept
of
Notification
non-communicable
Cancer,
Congenital
diseases
and
been
conditions
mal“ formations,
stroke and handicapped persons.
)
has
mental
notably
illness,
REPORTABLE AND EPIDEMIC PRONE DISEASES
>
I.
WATER BORNE DISEASES
1. Cholera
2. Diarrhoea
3. Hepatitis
4. Typhoid fever
y
II.
VECTOR BORNE DISEASES
1. Dengue fever
2. Filariasis
3. Japanese encephalitis
4. Kala azar (visceral leishmaniasis)
5. Plague
III.
VACCINE PREVENTABLE DISEASES
1. Diphtheria
2. Measles
3. r
* (whooping
■ ■
Pertussis
cough)
4. Poliomyelitis
5. Tetanus
IV.
1. Chicken pox
2. Food Poisoning
3. Guinea Worm
4. Meningitis
5. Yaws
r
V.
>
OTHER DISEASES
OTHER INTERNATIONALLY IMPORTANT AND NEW,
EMERGING & RE-EMERGING DISEASES
1. KFD
2. Leptospirosis
3. Plague
4. Yellow fever
3
CASE DEFINITION OF WATER BORNE DISEASES
Oasniliculion
Suspccl
______ Physician confi11nc11
__ Personnel
Uiy public/MPWs
________ Medical officers
Method
Medical officers
History
History + Clinical
_________ Investigations
Laboratory Identification
Acute Diarrhoea
Change in consistency and
character of stools
•
Three or more loose or watery
stools
•
Three or more loose or watery
stools
•
Mother’s opinion during infancy
«
Mother's opinion during infancy
•
Acute watery diarrhoea in older
children (>5 years) and adults
•
•
•
Cholera
•
Dysentery
•
Hepatitis (jaundice)
Fever, fatugue
Yellow colouring of the eyes and
None
Profuse painless watery
Isolation ofV.cholerae 01 or
diarrhoea usually with vomiting
0139 from stool samples
Signs of severe dehydration in
•
older children (>5 years) and
adults
Bloody diarrhoea
•
Change in consistency and
character of stools
Profuse painless watery
diarrhoea usually with vomiting
•
Ln I torn lory confirmed
•
Muscular cramps
•
Other cases of similar illne:ss
reported from the area
•
Mild cases are clinically
indistinguishable from non
specific acute diarrhoea
•
Decreased urine
•
Bloody diarrhoea
•
Fever and pain abdoman usually
•
Jaundice
•
Malaise, anorexia,
•
Fever at present or preceding
•
skin
•
Hepatomegaly
Right upper quadrant abdominal
«
Pruritis in some cases
•
Symptoms of diarrhoea or
dysentety
•
Associated with weight loss
•
Onset usually gradual with
increase in temperature
pain
>
Persistent diarrhoea
Typhoid lever
•
Symptoms of diarrhoea or
dysentery
•
Lasts more than 14 days
•
Sustained fever with gradual
onset
•
Severe headache
•
Malaise
•
Loss of appetite
•
•
•
ALT > 8 times of normal
•
Serum Bilirubin > 2 mg'X..
•
Hepatitis A - IgM HAV +ve
„*
Hepatitis B - IgM Hbe A. HBsAg
•
Hepatitis C - anti-IICV positive
•
Hepatitis E • IgM HEV positive
jaundice
•
Isolation of shigella sp. from
stool
~
positvc
None
•
Isolation of S.typhi from blood,
stool or other clinical specimens.
Sustained fever
Headache, malaise, bodyache,
anorexia, insomnia, thirst
•
Vague pain or general
uneasiness in the abdomen
•
General apathy
•
Constipation or diarrhoea
•
Tongue coated
•
Non productive cough
•
Relative Bradycardia
•
Splenic enlargement
•
Rose spots’ on the 7"' - 10 day
usually on the chest and
abdomen, vary in size and shape
)
3
)
■ \.IS\CS\|
I II l< •
/
Appendix-1
EPIDEMIOLOGICAL PARAMETERS OF EPIDEMIC PRONE WATER BORNE DISEASES
Epidemiological
Parameters
Diseases
r Causative Agent
Mode of transmission
Reservoir
> Incubation Period
Person characteristics
Case fertality rate
Cholera (0139)
Dysentry
Vibrio cholerae El Tor vibrio
Vibrio cholerae 0139
Shigella dysentry-1
•
Feco-oral
•
Feco-oral
•
Direct contact
•
Contamination of water,
food, milk, raw fruit
•
Contamination of water, food
•
Indirect (eco-oral
Human
Human
Human
3-6 days
3-6 days
1-7 days
•
Children &
•
Young adults
•
High (50%) in sever and
untreated case
•
High (50%) in sever and
untreated case
•
With proper treatment can
be brought down to <1%
•
With proper treatment can be
brought down to <1%
•
Cases increase during late
summer, monsoon & post
monsoon period
•
Cases increase during summer,
monsoon & post monsoon
period
•
Cases increase following
floods
•
Cases increase following floods
I Seasonality
Geographical distribution
Cholera (El Tor)
Can occur any where
All age groups
Can occur any where
c
^Healthy camers
Carriers & asymptomatic cases
Others
(^Control strategy
All age groups
High in children & elderly
Through out the year
•
Can occur any where
•
outbreaks more common
during dry summer
season
Camers can exist
Adults are carriers
Epidemic potential is higher than
El tor cholera
•
High infectivity (10-100
organism can produce
disease)
•
Secondary cases in
house-hold
•
ORS & effective case
management (antibiotic
resistance develops
quickly)
•
Sale water and
sanitation
•
I.E.C. for personal
hygiene
Safe drinking water &
sanitation
Safe drinking water &
sanitation
ORS
ORS
I.E.C.
I.E.C.
>
Miscellaneous
N.B.
|In addition to cholera,.shigella, nowalk agent, there are several other organisms which can be the cause of
outbreak of acute- diarrhoea.
------- These
•--J are Escherichia coli (several types viz. O157:H7 etc.), Salmonella etc. Other
organism responsible
for
food poisoning- are discussed in the training module
.
—-3 on food poisoning.
The action to be taken by the district health authorities to control an outbreak of diarrhoea' diseases are
b^'tena™6 St0° Samp'eS Sent 'n Car^ Blair rnedium
S8rve the Puipose o( isolation of most of enteropalhogenic
It may be re-emphased here that vaccination is not indicated tor cholera control
)
12
C:\.IS\Fi|(lmiid.<!«><■
Appendix.2
0F EP,DMC prone water borne d,seaI es
Epidemiological
Parameters
Diseases
_______
Typhod fever
Causative Agent
_______ Viral hepatitis-E
Salmonella typhi
Mode of transmission
Contaminated food, water
Reservoir
40 days
All age groups
Case fertality rate
•
Properly managed < 1 %
•
Through out the year
•
Cases increase during
monsoon & post
monsoon period
Human
~
1-2 days
Young adults
~~
•
High in pregnant women, <5
year and >50 years
Improperly managed and
non-immune = 10%
•
Feco-oral
Human
7-21 days
Person characteristics
Norwalk virus
Feco-oral
Human
Incubation Period
Acute Diarrhoea (viral)
[
H E virus
<15 years
•
Nil in properly managed
cases. It is
mild/moderate disease.
More of gastric
symptoms.
•
Through out the year
•
Can occur in winter
season
___ _____
Seasonality
•
Geographical distribution
Epidemic commonly during late summer, rainy & post
rainy season
Cases increases follows
floods
Can occur any where
Outbreaks occur mostly in those
Chronic carriers
Sub-clinical infection can occur
(no chronic earners)
Point source epidemic mostly
in rural areas
Control strategy
Can occur any where
areas having defective piped
water supply
Healthy carriers
Others
Endemic:- Through out the
year
•
Safe drinking water
supply & sanitation
•
Case management
•
I E.C. for personal
hygiene
•
Food hygiene
Can exist, but exact
magnitude not known
Secondary cases occur in
the^ame house-hold or
closed community like
schools.
•
Leakage in piped water
supply be repaired
immediately
•
Case management
•
I.E.C. for personal hygiene
•
Food hygiene
•
Chlorination does not kill
virus, but boiling will kill
Miscellaneous
•
General measures as
for feco-oral diseases,
•
outbreaks are self
limiting and of short
duration.
endemic, but outbreaks affecting younger age-groups can route’ m°stly drinking water supply. The disease is
Chlonnation kill the virus. Viral hepatitis B C D^nd r
,COnlrO' measu,es are simi|ar to viral hepalitis-E
B may occur in small communities like' hospitals a 6 Parenls"y '^milled. Isolated outbreaks of Viral hepatitis
community where private practitioner use unsterilised swinoeX^
Pa‘ien,S in *he *ard) a'ld in
carcinoma, cirrhosis occur after 30-40 years
needles. Chronic Liver Diseases (CLD) like
11
<
\- IS \ )■ i b |
i ii | J
f
i
WORLD
HEALTH
< A
ORGANIZATION
OS
PRESS
OFFICE
3W
^ly^ZTLLsrw L?
1111 G-NEVA 27 SWITZEHLAND •TELEPHONE: 791 2111 • CABLES: UNISANTE-CENEVE - TELEX-415 416 •
tv4" fro *
FAX: 791 074'
’J
Fact Sheet N° 1 07
(Revised) January 19Sc
CHOLERA
Cholera is an acute intestinal infection caused by the bacterium Vibrio choleras. It has a
short incubation period, from less than one day to five days, and produces an enterotoxin
that causes a copious, painless, watery diarrhoea that can quickly lead to severe
dehydration and death if treatment is not promptly given. Vomitino also occurs in mos'.
patients.
~
,
Most persons infected with V. choleras do not become ill, although the bacterium is
)
present in their faeces for 7-14 days. When illness does occur, more than 90% o"
episooes are of mild or moderate severity and are difficult to distinguish clinically from
other types or acute diarrhoea. Less than 10% of ill persons develop typical cholera wit.signs or moderate or severe dehydration.
Back □.round
The vibno responsible for the seventh pandemic, now in progress, is known as V.
cno/erae 01, biotype Ei Tor. i he current seventh pandemic began in 1961 when the
vibrio first appeared as a cause of epidemic cholera in Celebes [Sulawesi), Indonesia. The
i o^SS then spre3d r3P'd|y « other countries of eastern Asia and reached Bangladesh in
l~6d, India in 1264, and the USSn, Iran and Iraq in 1965-1966.
• •
•
■ ■ • •
i.
•
.
.
•
.
i
In 1970 cholera invaded West Africa, which had not experienced the disease for more
than 100 years. The disease quickly spread to a number of countries and eventually
became endemic in most of the continent. In 1S91 cholera struck Latin America, where
it had also been absent far more than a century. Within the year it spread to 1 1 countries,
and subsequently throughout the continent.
°b CaUSed S5d£miC ChOlera- SorT1s Xseroo
cod'd
S-S of diarrhoea, but not epidemic cholera. Late that year howt
‘2nXVUlbr£HkS °f Ch°lera bs52n in India and Banoladesh that
by a prev^
unrecognized seroqroup of V
\
31 were caused oy
vibrio has now been reoor-d fro^ w"’ deS'Snated °1
anonym Bengal. IsoMon o,
V. choleras 0139 will -xt-nd to T-b°
"“
.SouIh;=2SI Asia- i’ ia still unclear wl
situation is being maintained.
reS!°ns. and careful epdemiological monitoring
ChoLra is spread by contaminated water and food. Sudden large outbreaks arn
to.p^sonVomccrTnXXnd^ S“PP'y' On'V- rare'.V.'S cholara transmined: by direct pf
breastfeeding infants a?e rarXXX' " '* mS'
brackish water and es^ueri-s
Y
Sn7.t,nrn;n'and is
0' ''°Un9 chi!dren' al,h°
=f th. normal fie-
influenced by the t-mp-ra urs o th
“S0='a,Ed ”',h alSal bl°°™ <Pl=nkton), whic..
the pathogenic form of S
X”'""
arB als° ona °f th= '«ervo-
i reatment
When cholera occurs in an c
unprepared community, csse-Tatality rates may be as hioi
50% - usually because there
- are no facilities for treatment, or because treatment is (
too late. In contrast, a well-organized
response in a country with a well establ^f
diarrhoeal disease control
programme can limit the case-fatality rate to less than 1 %.
Most cases of diarrhoea
r nrpl roh
CauS5d fay
choleras can be treated adequately by giving
solution of. oral r nydratron salts (the WHO/UNICEF standard sachet). During an apid-.-r
80-90% of
o ■ lOea patents can be treated by oral rehydration alone,.but patients
become severely dehydrated
------ 1 must be given intravenous fluids.
ihe’pVXof vi’brio
"T
dUra,i°n 0' d'arrh°==i
<o rt is increasing.
- uce cctnmoxazole. erythromycin, doxycycline, chloramphenicol and furazolidone. '
c^icemio Control and Preventive-Mecsur = s
of ]“
=
..
n“
h
community !t ;S essential to ensure three things: hycienic dispo
SUPP,Y °f SafC drinkin9 ^StSr' a”d 90^ food hygL
I%'5'ene measures inciude cooking food thoroughly and eating it while
even inc cooked foods from being contaminated by contact with raw foods, includ
Fact Sheet N 3 i 0 7
Page 3
^2
water and ice, contaminated surfaces or flies; and l
avoiding raw fruits or vegetables unless
they are first peeled. Washing hands after defecation,
, and particularly before contact with
food or drinking water, is equally important.
Routine treatment of a
community with antibiotics, or "mass chemoprophylaxis”, has no
effect (on the spread of cholera, i
‘
nor does
restricting travel and trade between countries or
> between different
■ — regions of a country. Setting
J up a cordon sanitaire at frontiers uses
personnel and rresources
that should be devoted to effective c
control measures, and hampers
collaboration between
i
- ------ institutions
and countries that should
J unite their efforts to combat
cholera.
I he only cholera vaccine that is widely available at present is killed varHn
is widely available at present is killed '
parenterally, which confers only partial protection (50% or less) and
(50% or less) and for *
thi7rine to prren< or coniro1
to heahh authorities, who rna;'7he;n\o,;=rrn”7:«;cSXCeU^LXCCi"a,ed
3
r
• •
"
in 1 973 1the
...............
WHO World Health Assembly deleted from the International Health Regulations
the requirement for
presentation of a cnoieja vaccmation certificate. Today, no~country
requires proof of cholera
vaccination as a condition for
entry, and the International
Certificate of Vaccinarion
no longer provides a specific
space for [recording cholera
vaccinations.
stocks of two ora! cholera vaccines that provide high-level j
protection for several
months against cholera c
i caused by V. choleras
- ’ :01
- 1 Ihave recently become available in a few
countries. Bath are suitable for
- use by travellers but they have
e not yet been used, on a large
scale for public health
purposes.
■
;
notifica t i o n
Cholera is a notifiable disease locally, Nationally and
Internationally.
Health
functionaries
at
all
levels(particularly those who are
closest to the community such
as the Junior Health Assistants
Male and Female) should be
trained to identify and report
cases
immediately to the Medical
Officer.
Under the International Health
notifiable to the WHO within :24 hours Regulations, Cholera is
of its occurrence by the
National Government,
—t the number of cases and deaths are also to
be rreported
•
daily and weekly till the
area is declared free of
Cholera.
An area is declared free of Cholera when
twice the
incubat ion period(i..z io days) has
elapsed
since
the
death.
recovery or isolation of the last case.
*
•
Departmental Enquiries
K-R. SRINIVAS
Chief Administrative Officer
K.H.S.D.P.
A departmental enquiry is an enquiry ordered against a Government Servant
under the provision of Karnataka Civil Services (C.C.A.) Rules, 1957.
*
Whenever the authority empowered under the provision of K.C S (CCA)
Rules is satisfied prima facie that a Government Servant has misconducted or acted in
a way
------------ - Servant
e____ . „
___ dereliction in C‘ ,
,n
.y unbecoming nf
of a, r.
Government
or has .u
shown
discharge of
o ervant.
dUtleS’ etC” the Authority can initiate enquiry against Government
In an enquiry there are two stages:
1. Investigation or Preliminary Enquiry
2. Department enquiry under K.C.S. (C.C.A.) Rules
Whenever it comes to the notice of higher officer, Disciplinary Authority or
overnment that a Government Servant has committed irregularities in discharge of
is uties as Government Servant, before enquiry is ordered under K.C S (CCA)
^Sirvnf?)2Ce?ed Officer °r Authority may aPP°in£ an officer t0 investigate into the
■
y
he allegations. While conducting investigation, the officer can examine any
position inSpeCt any Slte or pIace and ver*fy any record in order to know the correct
1
Then the Investigating Officer will submit a report to the officer who has
Zhoritv ZTr0"' B33ed °n-the repOrT °f the InvestiSating
the Disciplinary
K C
icr . h.e G°vernment as the case may be will decide whether enquiry under
K.u.d. (C.C.A.) Rules is necessary or not.
i
Auffioffiy orffie Appo^ng SrityTs^e^thTt
Government Sp
^1StS aSa‘nSt Government Servant- il can proceed against
Lrovernment Servant under K.C.S. (C.C.A.) Rules.
)
evidencf'^hLfH
S’33'3 °f Investi8ation RePort or on the basis of available
RuA II ’or i?8^
h3Ve t0 bC framed againSt Govemment Servant either under
■
- of the Rules. If two or more officers are involved, a joint enouiiv is
orcere un er Rule 13 of the Rules. If the charges are proved after enquiry, one of the
per.a ties as prescribed under Rule S will have to be imposed. If on enquiry if charges
re not proved, the Government Servant will be exonerated of charges.
he nUrL°mellmec Government Servant against whom the enquiry is contemplated will
3
under RuleUm
SuSPension as Provided under Rule 10 of the Rules. A suspension
when rhe irre IS|nOt 3 punishment A Government Servant is placed under suspension,
gulanties appear to be serious and if the Government feels that his
.s?3continuance in the post will hamper further investigation etc. During the period of
suspension, a subsistence allowance is paid to Government Servant.
A Government Servant who is placed under suspension could be reinstated at
any time either before completion of enquiry proceedings or after completion at the
discretion of the Disciplinary Authority. If charges are not proved, the period of
suspension will be treated as on duty. If the charges are proved and a penalty is
imposed, the period of suspension will not be regularised. However at the discretion of
Disciplinary Authority, the period may be adjusted against any leave at the credit of
Government Servant.
Based on preliminary enquiry (Investigation Report) or on the basis of available
evidence, the Disciplinary Authority will frame articles of charges against the Accused
Government Servant (AGO/DGO) either under Rule 11 or 12 as the case may be.
If in the opinion of Disciplinary' Authority, that irregularities Committee are
minor ones, he may initiate enquiry under Rule 12 of the Rules. If enquiry is order
under Rule 12, only one of the following minor penalties can be imposed against the
A.G.O.
1. fine (for Group ‘D’ services only)
2. censure
3. withholding of increments
3 a. withholding of promotion
4. reduction to a lower stage in the time scale of pay.
If in the opinion of Disciplinary Authority, that the irregularities committed are
serious ones, he will initiate enquiry under Rule 11 of C.C.A. Rules. If charges are
proved, the Disciplinary Authority may impose any of the following major penalties
under Rule 8.
(v) reduction to a lower time scale of pay, grade, post or service.
(vi) compulsory retirement
(vii) removal from service
(viii) dismissal from seiwice
Even when an enquiry is ordered under Rule 11, the Disciplinary Authority can
impose any of the minor penalties also. But whenever an enquiry is taken up under
Rule 12, no major penalty can be imposed on the A.G.O.
The procedure involved in conducting an enquiry against A.G.O. is to be
followed scrupulously otherwise enquiry' will vitiate.
On the basis of preliminary investigation report and or on the basis of available
evidence, the charges will have to be framed against the A.G.O. The charges should be
clear and distinct. There should not be any ambiguity in the charges. The charges ill
have to be explained in the form of statement of imputation of misconduct. The
documents by which the article of charges are to be sustained and the list of witnesses
'l
to be examined by the Disciplinary Authority in
support of charges will have to be
listed along with Articles of charges.
documents'lis'ted'and ,h,°"S,
Of imP“'“°n Of "’■conduct, list of
The A G 0 should be' rT' 11635
e,X.amined Wl11 have t0 be served on the A.G 0
statement of h.s defence X^t^
SUbmit 3 Written
On receipt of this
himself or appoint an engX'X'Io'
A.G.O.
then
which are
notrhe"“doby Z A G °
amhority compel .T
cZJ^
oZhC'aretdmitudtZ
Disciplinary Authority
can impose any of the
penalties as the case may be.
Disciplinary AuthSty mX^inquirf^ntoX^cha^61116'11
h'S defence' then also
Disciplinary Authority may also' anno’
°£apP01nt an inquiry officer. The
presenting officer on behalf of the Discipl^Xthorky"
officer a^eVgeZg^^reXt're '
shall appear'n peX beZ he ^
assistance of another Go vernmo
a legal practitioner
7
t0 be PreSent before W
Th* A.G.O
c
qU1Fy Authority. The A.G.O. may also take
Se™nt °r a -trred Government Servant who is not
the charges or’Z A^GO 'Xtotfeh^“rh"''' h l,'r t A G ° “ S“il,y °f
of
OrScer and take signature of the A G O
reCOr<,ed by lhe InW
his absence or^est XX'e t"' tt"17
Wi,h°“
produce .be
“
The A.G.O. i y ;
may is'
!h
"y °f the d0“™”“ “P permit him to
take extracts of statement
—ts listed m the charge memo. The A.G.O. may be allowed to
submit a list of witnesses to be
examined on his behalf
I
:t:..rs3E£;‘ ™“
;*™...............
j
The A.G O. r-'
examined by P.O. and
also put questions.
j
The Inquiry Authority after completion of production of evidence permit the
c same The
A“",ori,y may a‘”
After completing enquiry, the Inquiry Authority will draft inquiry report to be
su muted to the Disciplinary Authority. In the inquiry report, the Inquiry Officer will
ave to analyse, each charge on the basis of evidence placed before him and record his
mdmgs on each article of charges. These findings will be submitted to the Disciplinary
utnonty in form of inquiry report along with documents.
The Disciplinary Authority after receipt of inquiry findings will examine the
report of the Inquiry Officer and proceed further. If the findings reveal that the gravity
ot the charges is not serious, the Disciplinary Authority may impose any of the°minor
penalties under Rule 8. If in the opinion of Disciplinary Authority, the gravity of the
c larges is so severe that, it warrants a major penalty as specified under Rule 8, the
isciplmary Authority may impose major penalty if he is competent to do so or
onward the inquiry report to the Authority competent to impose a major penalty:
_ If D,sclPlinary Authority is the Government then before imposing any of the
major penalties, the KPSC will have to be consulted. If the Authority subordinate to
overnment is the Disciplinary Authority, then there is no need to consult KPSC.
Before imposing a major penalty, a second Show Cause Notice to be served on
t e A G O-, enclosing copy of the inquiry report. There is no need to intimate the
penalty proposed.
Against order of the Disciplinary Authority, the A.G.O. c«
can file an appeal to
the Appellate Authority. Appellate Authorities .are prescribed for
various classes of
services as given in the classification.
When an enquiry is ordered under Rule 12, a detailed enquiry may be held in
accordance with the procedure laid down in Rule 11, or on the basis of articles of
c urges, statement of imputation, defence statement, evidences placed, record findings
and impose a minor penalty as given in Rule 8.
When two or more Government Servants are involved in a proceedings, the
Disciplinary Authonty may order joint enquiry under Rule 13. Even in a joint inquiry,
t e Rule 11 or 12 may be followed depending on the severity of the charges.
The Government can appoint Lokayukta Officers as Inquiry Authority under
ule 11(4) of the Rules. The Inquiry Authority can in such cases modify or alter the
articles of charges but they cannot frame the charges on their own.
Special Procedure in certain cases:
The Competent Disciplinary Authority under Rule 14 mav without holding any
inquiry contemplated under Rule 11. 12 of the Rules, impose’any of the penalties
specified in Rule 8 on Government Servants.
1. on the ground of conduct which has lead to his conviction in a criminal
charge.
2. a) where he has absconded.
b) where he does not take part in the inquiry
c) where Government is satisfied that in the interest of security of state, it
is not expedite at follow the procedure in C.C.A. Rules.
The important Acts and Rules to be familiar with:
*
1. K.C.S. (C.C.A.) Rules, 1957
2. K.C.S. (Conduct) Rules, 1966
3. K.C.S. Rules
4. The Karnataka Finance Code
5. The Indian Penal Code
1
>
>
)
5
HOW TO EXPRESS YOUR P5ELIMGS5
1
"B.
O jJ.
DANIEL A. sugahman/rolaine hochsteFn
& thl. brier .rtlol. the .whore .tie.pt to
x
«.ior reason, r.r th.
rwinres tn
Beven principles derived from recent work in hn
n +•
should
+ <
1 human relations that
should help to improve your comuzucations
otherS( both fis
sender and as receiver. Although the various principles are
presented as unqualified directions, they, like most useful
principles, should be applied judiciously in response to the
specifics of each communication interaction.
7
Doris: " I really don’t care which movie we go to". (She is
telling her husban that she ia so happy to get out^ it doesn't
where they actually go).
Phil: “if you’d rather stay home, 71 can find plenty to do around
here. (He thinks she doesn’t want to
-J go).
Joans "I am sorry, 1but we can’t join
.
you Saturday night." (She
doesn’t enjoy big parties at Mary
J’s country club.)
Mary: " I’am sorry, too." (Mary thinks Joan doesn’
t like her. )
Betty: "Everything has gone wrong today / (She wants a little
sympathy from her husband. )
Tom: " All you do is complain.*" (He thinks she’s blaming him.)
Ann: "The Women’s Libration movement is the greatest thing since
frozen vegetables." (She is glad to see new educational and
career opportunities opening up for women.)
Sally: “it’s a lot of nonsense." (Her neighbor pictures a group
of disheveled activists picketing a men’s bar.)
Any of the above dialogues could be the begining of a fight or
the end of a friendship. Doris and Joan and Betty and Ann send
out one message, but the receiver picks up something entirely
different. Each knows what she’s telling her husband, friend
or neighbor, but the response-Or lack of it-indioates that the
other person hasn’t the faintest idea of what’s really on her
mind.
Their problems are not unxisaal.
difficulties from time to time.
We all have si mil ar
If you have continual misunderstandings with the people
close to you, havever, you may soon feel isolated, lost, powerless.
It is important, therefore, to learn how to get your real
feelings across. In recent years scientists concerned with
communication and psycholinguistics have learned a lot about
how people talk to each other. Some of their findings can help
)
1
-
I
2
/
you to make yourself better understood. Hrst let’s examine, some
of the causes of the flak, fuzz and static that prevent understandii
1. V/e don’t really listen.
The average English-speaking person
hears more than a billion worxls a year.
Bombarded by so much
verbiage, many of erect barriers to screen out much of the talk
lest our circuits become overloaded.
One woman, for example,
described her daily routine with six children, a dog and a parakeet
by saying, "If the noise stays about as loud as Niagara Balls,
I know everything is all right and I hardly bother to listen. But
when it rises to the level of a jet plane taking Off, I Imow it's
time to go upstairs and find out what the trouble ih
M
2. We assume that words have prcise meanings-and they don’t
At
bottom, a word is only a symbol-one largely de find by individual
experiences. When experiences relating to a word have been
different, the receiver "hears" the communication differently.
For example, Alice Grayson grew up in a home relatively
stable and free from iajor Strife,
affectionate people.
hand, was
Her parents were very warm and
Bob Grayson’s childhood home, on the other
characterized by constant bickering.
He often witnessed
physical assaults upon his mother by an alcoholic, irresponsible
father.
W^en Alice and Bob came to me for marriage counseling, it
soon became clear that the word "marriage" conveyed different
meanings to each of them©
When Alice spoke to Bob about 'marriage .
she implied warmth, intimacy and stability.
When Bob spoke to
Alice about "carriage", he seemed to be talking about a sort of
jail term in
which he had to protect himself from criticism and
attack.
in which it
is used. We speak, for instance, about a fast runner (meaning spt
who leads
about going on a fast (not eating) or about
i---- a neighbor
- at
a
social
a fast life.(meaning immoral). Not long ago I was
CA .
A word's meaning may also vary with the content
where an animated discussion arose on the subject, of
gathering
listening carefully, I realized that to the original
women’s lib.
c7
- 3
Speaker, women’s lib meant that a women should be paid as well as
men. To another woman, women’s lib connoted an equal sharing of
household chores. To a young man, women’s lib seemed to suggest that
he would stay home and clean the sink while his wife drove a trailer
truck and went to communist Party meetings.
b' When people come from different cultures, their problems in
exchanging messages are greatly compounded. To someone who grew up
in East and is accustomed to carrying groceries in paper bags, it
causes momentary alarm to be confronted in Arizona with the prosper
of having to carry home a sack. In California people goto the beach
on a hot day. In New Jersey they go to the shore.
3. We don’t pay enough attention to tone, gesture and other nonverbal
forms of communication. Recently a young physician and his wife came
to me for help. She complained that he treated her as a little girl.
He, on the other hand, spent the session denying the charge in a very
intellectual manner. Infact, he said nothing to indicate a patronizing
attitude. As thej were about to leave at the end of the session,
however, he patted her arm in a condescending fashion and said,
" Now that wasn't too bad, was it?" Hisgesture and tone of voice
thoroughly corroborated his wife’s complaint.
CiBecause nonverbal communication often speaks louder than words,
the sensitive person must be alert to signals* the smothered yawn of
boredom, the swallow of anxiety, the jutting chin of defensiveness,
the hair-patting hand of nervousness, the widened eyes of fear, the
small smile of disbelief and dozens of dither bodily movements that can
reveal the hidden agenda of communication patterns.
4. We say what we think we should say instead of what we feel,
The
meaning of words can be lost in the frequency of their usuage. If
you repeat the wr of a friend fifty times in rapid succession, an
interesting psychological phenomenon will occur. Bor the first dox-en
times, the name will bring an image of the friend to mind. After that,
the name will become just a sound-and more meaningless with each
I
repetition.
A
Greetings and social rituals often meet with the same fate. The
How-are-you?- I’m-fine routine is probably the most common illustration,
and in many ways the saddest, I have known people who were literally
suicidal to reply, " I’m fine, thank you. How are you?" whdn asked
how they were feeling.
Ironically, some of the most significant occasions in people’s
lives-such as commemorations of birth, graduation, marriage and deathare often marked by the highest incidence of meaningless, ritualized
communications. At weddings and funerals, when people are most deeply
moved, they tend to hide their feelings under a cloak of banality.
4
/
A woman who had lost her daughter after seven long years of
a painful, wasting disease told me that nne of the worst ordeals
at the funeral was having to shake the hand of person after person
who said " I’am sorry” or "What can I say?" At one point, however,
a close friend broke away from the ritual and said, "I know it has
been terrible; I’am glad for her and for you that it’s over.” The
mother cried then, able at last to express her grief. "It was
good to know that at least one person there was generoud enough
to share her real feelings with me," she said later.
It is easy to follow the script of conventional comments and
responses, but meaningful communication requires that you take the
trouble to create original dialogue that expresses your own unique
feelings.
In recognition of the critical need for improved understanding
among individuals and groups of people, a human relations movement
has become a forceful element in American life. Some of the
principles and practices ani that have been found to work in human
relations training may help improve your communications with
friends and loved ones.
1. Acknowledge your feelings. The lines of communication often
get crossed by yur desire to say things that will gain approval
even though they conflict with our true feelings. For example,
women conditioned tb the traditional female role in our culture
generally find it difficult to admit-even to themselves -feelings
of anger, boredom, sexual appetite and competitiveness, while men
are often inhibited from expressing “weak" emotions such as fear,
tenderness, indecision. Mature people are capable of acknowledging
all their feelings-even those that are socially taboo.
When you are angry, for example, the worst thing you can do
is withdraw. A blanket of self-pity or self-righteousness may
bring temporary comfort, but it also creates a barrier between
you and other people. The best way to deal with anger is through
a direct confrontation that balances your feeling with the other
person’s sensibilities-provided, of course, that you confine your
message to the issue and not the personalities involved.
a. •
k
Attacks and accusations-"You’are seifist f .*
"You’re
inconsiderate
" "You’re lazy
- don’t solve any problems.
But a specific statement- " I'm angry because you left the
■bathroom a mess last night and you knew my bridge club was
coming over "-defines the issue, leaves room for apology and
future correction, df you use a fifty-megaton bomb to get
rid of a mosquito of annoyance, your target is apt to erect a
protective barrier through which no message can penetrate.
5 2. Stop, Look and Listen.
types of
Sometimes, the habit of tuning out certain
conversation-children’s prattle, fellow workers’ shop talk,
a neighbor’s gossip-causes us to miss some important messages. As an
listening
early step in improving your ftOTmnunications, reassess your
habits.
Tn recent
a. learn to catch the cues of nonverbal communication.
laboratory that people
years psychologists have demonstrated in the
You
broadcast their feelings in a vide variety of nonverbal ways.
the glance
need not be a scientist to pick up many nonverbal ouess
at a watch
that indicates restlessness, the tapping foot of annoyance,
Arms crossed at the chest may
the clenched fist of suppressed rage.
indicate reserve, while pursed lips may signify the desire to say
Learn to watch for revealing signals,
things unpleasant to hear.
to listen objectively and to interpret what you see and bear.
If Loris and Phil Evans had learned to listen with more
According
sensitivity, they could have averted a family quarrel.
to Loris, Phil came home, made the gesture of inviting her out to a
movie and then, much to her disappointment, reversed himself.
According to Phil, Boris said she didn’t want to go, "Loris explained.
I was so
"What I said was I didn’t care which movie we went to.
with being home with the kids on arainy day that I didn’t care
bored
where we went.
Hecognissing his mistake, Lhil admitted, " H guess I took you
)
busy day at the office and was really glad
up wrong, I ’d had a
I guess I heard what I wanted to haar.
to stay home.
we radily
Since most of us like to live in anordefcly world,
desires and prejudices to
gtllow communications that confirm our
that
field of awareness, but we x screen out messages
entre our
The individual who really wants to send
go agaubst bur wishes*
paying objective attention.
and receive clear messages will work at
When your conversation is sprinkled with
3. Explain yourself.
“You know what I mean?” it’s safe to
such nontalk phrases as
assume that your meaning is not clear, Lazy talk is the cause
Setty, the woman who greeted her
of much communication failure.
"everything had gone wrong today
husband with the news that
)
>
6
lost the sympathy she wanted
because Tom heard
en accusation and
reacted to defend himself. Her
message would have been far more
effective if she had been more specific: ‘‘
'Little Tommy fell out of a
tree and hurt his rarm, the washing machineJ broke and I forgot
to take
the meat for dinner ,
out of the freezer.”
In busy lives, it’s all too
easy to generalize, take shortcuts,
confuse facts with feelings.
The expressions "I feel" Or "it seems to
me” are valuable tools in r
avoiding misunderstanding. Your facts may be
wrong, but the vay you feel cannot be
------disputed. "I'd prefer less salt
in the soup” is
a very different statement from "why do you always
over-salt everything?” Hasty
responses suoh as "You're wrong" or
"don’t be silly”
are inconsiderate of other people's feelings.
furthermore they invite
counterattacks or retreat. If you want an
exchange instead of a battle, explanation is n
more useful than attack.
"This is the t —
way I see it” goes further than ”'You don't know that you
are talking about. ii
All too often a husband will say, "i>m
There is not much a wife can do with that < sorry I ever got married.*
except feel wounded and
strike back. If the husband said" J'
I’m beginning to feel trapped.-...
Ar ” All these
responsibilities get me down sometimes
channels of communication would be
open. And
; ' an honest discussion
of the real problems might improve the situation.
up to^our1S nOt •the responsi'l!ili^ of your loved ones.
P
to say what's on your mind-and up to them to respond.
ing specific, givlng ciear
make
that the
aSout.sure
Callie
L reopivpr
receiver n-r
of your r
strai
M
It is
Sy
language, you can
Calling to tell a friend that
• you had "a good time” at her
house last night doen't mean nearly as much
The shrimp creola was delicious and the
My husband said he hated to leave.
meaning across.
it
1 as a specific statement:
Jacksons were great fun.
Such details really get your
4. Avoid detours, Some people find it almost
impossible to ask a
straight question or give a stright answer.
Somehow-whether from
a need to guard themselves, a mistaken attempt at delicacy
or plain
fuzzy-mindedness-thej' get into the habit of indirection.
The Alberts? for example, continually invite the Massons to
parties at their country club.
The Massons dislike formal dress.
Joe Masson doen't dance, and Joan is uncomfortable with the kind
of small talk that dominates at the club. Every tine Mary Albert x
vi es them, Joan invents a tactful excuse for reusing the invitation.
Eventually the Alberts will get annpyed at these rejections and
may even drop the friendship.
I
7
It would be much better if Joan just said right off: "Look,
we enjoy being with you, but we don’t enjoy the club. How about
doing something else together?"
1
It’s all too easy to get caught up in polite lies, meaningless
formalities and convenient evasions.
If you want closer connections
to the people around you, honesty is a better policy,
Stzart by
avoiding the white lies that can destroy trust and confidence.
Telling a friend that th her prune casserole is delicious when
you can barely manage one mouthful doesn’t accomplish anything.
She’ll know your real feelings wheh she sees the expression on
your face when you swallow~or the amount you leave on your plate.
And she’ll be doubly offended by the obvious lie.
In the long run it’s usually wiser to tell the truth-even
if it hurts.
The consequences of not facing the truth are often
more painful than the truth.
To communicate unpleasant messages
as kindly as possible is a skill worth developing.
Bor example,
the hostess who served the offensive prune casserole might be told:
"I really admire your creativity with new dishes, and I usually
love the results, but this is one time is one time when it
just doesn’t appesal to me."
5. Offer feedback: When a friend tells you a long story over the
phone, you fill in the pauses with sounds of encouragement. "Yes...”
"Go on..." "Um-hmh
!
" If you stop sending this feedback, she
soon asks if you’re still,there.
J^ce.to-face communication also benefits from feedback-such
as eye-tQ-eye contact, nods of understanding, comments of agreement
(or Even disagreement).
If the person taking gets the feeling
that you are truly interested and accepting, he is encouraged to
continue.
If he senses disinterest or disapproval, the flow of
communication soon stops.
Viola Jchnson, a woman with two grown children, told me she
was bored with her marriage and considering a divorce. When I
asked what she and her husband usually talked about, she snapped,
’’Engines." since she obviously had no interest in engines, I
*
^3
8
asked, "Why don’t
you change the subject?” Viola
was surprised at
the nuootion.
A wi-To io ouppoocd to Helen,
”0he said. But by
withholding honest
feedback, ahe failed to
let her husband know
where he stands.
If Viola really wanted to enj oy his <-company, 8he could have asked
questions-possibly learning
some details of his
’ work that would
produce an interest
on her part. Or she could ;
ask politely for a
change of subject that would
give her husbang s chance to make
himself more interesting. Best
°f all, she
-ue could
couid suggest an activity
a dance class, a
painting course, volunteer
volunteer civic
civic work-thaty they
could do together
and talk about to their mutual interest
a) You should
-ver be afraid to say " y don't understand." pt's
really a courtesy, for it shows that you think enough of th
you think n ugh of the message
and the sender tn u + +
sender to want to catch
+.
catch the
the point or
* —J or
or see the picture in
proper focus, Most people
are happy to restate what they have just
said in order to
oldMf, it-nd the, are el.d
e,„ eaou£h
6, Don't label.
»0bdd, really m.
Prej udgement a., prevent maer.t„al„g „„ ltelt
J
of a relationship.
^°n and Greta lewis c. to „
concern about
noon about a
Co«s..lfag
a sesual problem that began, they said,
before.
on their honey-
It ee^.a th.t So„
!
While Greta i”3°"^ tX’TT
-er longer to
reach a climax,
0» ths third Jaj of them tatl.moon,
kl„ea
and said,
I love joo „rmaoh. „„ th„gh jou
Although inexperienced in sexual matters
sex manuals and felt increasingly anxious about Greta had read several
tier "frigidity."
mtercourse soon became a chore to her.
She found herself
concentrating tensely on mechanics rather
than relaxing in the
enjoyment of love-making. The more
frantically she sought pleasure,
the more it eluded her. Mnaly, she indeed became
unresponsive,
listening to Eon and Greta, I sas convinced that +hO<
began with Hon<3 labeling of Creta as "fMgid., mgiaityt
sychologists,means the lack of pleasure in sexual activity,
This
was not true of Greta-until anxiety caused her to fulfill the
prophecy of Ron's label.
9
■
•» a"drunkard" will likely reinforoe
a) In the same way, calling a man
nothing to help his drinking problem.
his negative self-concept and do ]
, without labeling-” I am worried about how
But a sympathetic approach
will have a better chance’ of
much you’ve been drinking lately”of his defensiveness. Much of our achievement
penetrating the wall
Children persuaded that they are backward
depends upon self-image,
But when the same children work
usually perform poorly in school,
I
with a teacher who is convinced they can learn, they often show
remarkable improvement in a short time.
b)
If your aim is to improve relatione-rather than to express feelings
of hostility or
1
“You’re stupid,
superiority-don't confine people under sticky labels.
"You’re stingy, ’'You're a^ tyrant, "You’re a bore" are
in dealing with a problem. Such labels serve as an
never effective
reasonable discussion of grievances.
effective barrier to any
Most people resist change. They “don’t
7. Take off your blinders.
their habits and viewpoints. This
get"•’ messates +.hn+
that are
are at odds with
engaged in an extramarital affair is often
is the why the wife of a man
She doesn’t, want to know, so she
the last person to know about it.
fails to register the obvious evidence.
Protecting ourslevea from, unpleasant comunications that are
clearly sent is what psychologists call "the ostrich phenomenon.
Ostriches, with their heads stuck in the sand, are extremely
their
vulnerable. So are people who let their blind spots influence
+z>-r ra.iJ+v
The woman who does not see-because she is
l
child is delinquent, that
really afraid to see-that her
•is dissatisfied, that her friends are exploitins her is not only
failing to get a message, she’s failing to make the changes that
could improve the situation.
Of)
To avoid the amdero of the "OsVlok Pteno..aon " yo» must
I
mderetoa ate »
a better
*, r
lAbf yourself 1. set all
pjraon Is irytas lo tell you. Jo« are
Of, „6u».at.
If yea —'lth
anJ fears you'll be able to H=ten to divergent rl.vpolnto wl
X mind’ You am listen without agreeJug, but It'. l«P°r «»
listen first-then make up your own mind.
)
Once you understand a communication, you may occasionally
it useful to "tune out" parts of it.
I recently worked w
1
optp distressed about having placed thex*
elderly couple who were
)
an
-
10 -
retarded daughter in an institution because they no longer had the
stamina to care for her at home. luring the interview, the husband
often interrupted his wife with irritable comments. At one point
ho beoomo frankly abusive, but his wife turned to me and said.
Pay him no mind. Doctor. He s just got to get the pain out somehow."
She was a woman who had learned to recive and interpret
messages
and
to share another’s feelings.
bjj If you truly want to be coser to other people, you can learn to
be more expressive and more responsive. The key is wanting to
communicate-rather than to win points, make an impression, assert
power or reinforce your own attitudes. The point-winner is less
interested in understanding other people than he is in putting himself
across. Sometimes, in order to put a eonversation on a level of
honest exhange, it is necessary to say (and mean .’)s "Look, I’m not
tyying to put you down. I only want to understand why you think that
way."
If. you can’t hear another person’s story without interrupting to
show howu much you know or where you have been or how bright your
children are, then you’re probably more interested in Impressing
him than in relating to him. If you can’t listen to an opposing
view point without trying to change it, self-assertion may be more
important to you than understanding. If you calm up in the presence
of opposition or ideas of which you disapprove, it is likely that
you’re afraid of the challenge of the new and different. Only when
you really listen to another person and try to see things from his
point of view are you practicing the art of communication.
c} It’s important to keep in mind, though, that not everybody wants
intimacy. Not everybody will feel free to open up to you. If you
are a freiendly, warm, outgoing person, you will probably want to
respond to the needs of others who, for one reason or another, may
choose to remain aloof and restrict their confidences. If your
overture at a party is not welcomed, it’s easy to move on to someone
more congenial. Sometimes a rejection is very frankly seated:
"Steve and I would rather not discuss politics" or " I never talk
business at social gatherings." At other times you can tell from
downcast eyes or a defensive lift of achand that you are in danger
of intruding on delicate ground, A graceful retreat or a change of
subject is in order.
d^ With intimates, too there may be tender spots on which you should
not tread heavily. If your husband feels touchy about his expanding
waistline, his receding hairline or his unchanging salary, it is
considerate to approach these subjects with discretion-if you mention
them at all. It is part of sensitivity to recognize and respect
another person’s privacy in certain matters.
)
11
In shbrt,' you may not always succeed, but your efforts to.get
across will certainly
1
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1
I
1
make life a lot eaeier-for yourself as well
as everyone around you.
MATldriAI. HEALTH
I’RO-AMMH.',
THEIR Tl. J E< T I V E.1: Al Hi
IMPLEMENTATION
r
The National Health Programmes are formulated and launched
by the Central or National Government to improve the Health of
the people on specific health problems after the independance.
Objectives of National Health Programmes:1. To cohtrol/Eradicate
the Communicable diseases,
2. To improve the environmental sanitation and provide safe
drinking water,
3. To improve the Nutrition
4
4. To Control the population growth and promote the Health of
the people, particularly the health of children and Mothers.
Technical and Material Assistance:
is provided by International
Agencies like, WHO, UNICEF, UNFPA, WORLD BANK and Number of
t
Foreign Agencies like SIDA, DANIDA, NORAD and USAID.
NATIONAL HEALTH PROGRAMMES;
I.
DNational Malaria Eradication Programme:
Malaria was and is one of - the major public health problem.
1
In 1950's it was number one Public Health Problem in
India.
As per 1953 estimates yearly inci.'dance was 75 million cases with
8 lakhs dsxiKhx deaths.
t
The National Government launched National'Malaria Control
Programme in 1953 as a centrally sponsored programme to reduce
the morbidity.and mortality due to Malaria.
The Malaria incidence
was brought down to 2 million cases in 1958 Lrom 75 million cases
1
in 1953.
The Central Government upgraded the programme as
Malaria Eradication Programme in 1958 due to spectacular success
and fear of development of resistance of vectors to DET.
NMEP had a spectacular success .
The
In 1961 only 50,000 cases
were reported and most of the areas entered the maintenance phase
by 1965.
of the programme : oile to various problems in maintenance of
the programme.
again the incidance of malaria started rising in
many areas even epidemics were reported.
Muring 1977,
a total
of 6./1 million cases were reported with fev/ deaths.
. .2. .
2
The Government of
Inila implemented mo li f io-1
an o1
orx? ration. to prevent deaths due to malaria,
to reduce morbidity
and mortality due to malaria.
and to maintain the
Envelopment in
the field of Agriculture and Industries.
incidence in the North-East region,
To contain the PE
special nroerafrime viz.
plasmodium falcifarum containment
procrramine v/n.e latinehe<l including
the tlrug resistance problem.
The guidelines are chaneed to
contain the
spread.
Activi ties: DAttack on the parasite- prompt case Hi—i ir,p f,y
An^Ce1an'1 P*ssiv- ;>”rveiJLlance ap! .iro„„,t treatment
ano reduce the reservoir of infection.
2)Attack on Vector - i) Rioenvironruental method of vector
control.
ii)Indoor- insecticidal snray with
appropriate xnxd insecticide as
anproved by the Central Govt.
3)Awareness c
campaign
regarding the malaria, causation
spread, signs and symptoms, diagnosis and treatment
^nd prevention.
'’he
programme is implemented through the following.
State Headquarter:- A cell is established - 1
Divisional level - Deputy Director NMEP Zone - 4
District Malaria Officers -20+7 (New Dists.)
Primary Health Centres - 1601 and
all other health institutions; Drug Distri-.ion Centres and
Fever Treatment Depots.
Strategv:1) Surveillance - Active - Jr.H.A(M), Jr.H.A(r) p 3r.H.A(rv,p)
— Passive
All Medical Insti‘.i.i t ions
-Mass and Contact.
2) Laboratory Diagnosis at PHCs.
3) Prompt Radical Treatment of cases
4) Indoor insecticidal spray and nioenvironmenta 1 control methods.
5) Operational Research - Vector behaviour anl sensitivity to
insectic ides
- parasites sensitivity to ch 1oromj ine.
The malaria incidence yearwise in the State is '"ri ven in the Annexure.
l
3
3
7.. National Filariasis Control Programme: Pi la riasis is another public health problem in I n'l in.
t
About 304 million people are exposed to the risk of? infection
and 15 mil lion people with meniiest disease and 21 mill ion ry-?ople
are having Micro filaria in their blood
per recent estimates.
The National Filariasis Control Programme is Launched in
)
1955.
This programme is integrated with Urban Malaria Control
Programme in 1978 to have maximum utilisation of resources.
Activities of MrcP:1) Delimitation of problem in the unsurveved areas,
2) Control in the Urban areas,
iRecurrent Antilarval measures
ii)Antiparasitic measures with D.E.C.
In Karnataka the problem of filariasis is seen in the Districts
of Dakshina Kannada, Uttar Kannada, Bijapur, Gulbarga and Bidar.
The following infrastructure is created for implementation
of this programme:
1) Filaria cell in the State HO. - 1
2) National Filaria Control Units - 8
3) Filaria Night Clinics - 25
4) Filaria Survey cell-- 1
The programme is in operation in the problem districts.
t
The Govern-
ment of India supplies the equipments and materials and rest is
met by State Government.
The yearwise achievements is given in Annexure.
3«.National Family Welfare Programme:
Government of
India recognising the need of population
control, launched Family Welfare Programme in 1952 all over the
country becoming first country in the World to do so.
)
. .4. .
)
4
Mile stones o_f programme development: -
- Government run Airth Control CLini cs stari-nd in 19305
in then princely State of Mysore.
National Family’Planning Programme launched during 1952.
Activities:
- Establishment 06 few clinics to provide serv
- Distribution of education materials
- Training and Research.
- Change from clinic approach to extension education approach
in 3rd five year plan. (1961-66)
- Motivation of people for acceptance of Small
Family Norm .
Introduction of IUD in the programme - in 1965
seperate Family Pinning Wepnrtmont: in the
Health Ministry - 1966.
~ FamiJ^Pl^n^ OfcFC’ str^cture
Subcentre, Urban
amrly Planning Centres, State and District Pureaues)-1966-e
Top priority programme - During 4th Five Year Plan (1969-74'
In 1970, the F.P. programme became integral
part of MCH Activities oE PHCs/Subcentres.
- All India Post Partam Programme in 1972, MTP was introduces.
Fifth five Year Plan (1975-80) - Major changes.
- In April 1976 - First National Health Policy
f ramecl.
" in^MtnlZtA^ pOpulation PTicV wns
aru Ministry was renamed as "Family Welfare".
'
anH F’TilV
Janatha Govt,
—
the cuncurrent •
..»ae “e«u“"fr^TT tO
provision is
The acceptance of programme is purely on
volutary basis.
India is signatory to the Alma Atta declaration
Health for all by 2000A9 through Primary Health Care.
to achieve
Accordingly
National Health Policy was formulated inlh?32. and same
was approved
in 1983 by the Parliament and brought into force.
Long Term Oomocraohic Goals s^t in the noonlatier noiic
achieved b^ 2000ai^
i (2 child Norm)
2) Birtli Fiato - 21 per 1000
lOpul-Ttion
3) 00.31:1, r-.-jto _ 9
1000 popu] tion
4)”
■ I- . ,roi • .!:i- i on i!.,i r, _ po ,1r, ,
_1p33 than 60.
F
r
1 Of)
to be
5
The Family Welfare Programme was a taront or j
arid
timebound programme, but implemented on puro.l y v,o 1.1 in (.a ry basis.
During 1995-95,.the proqramme was made
"'Target r'ree Approach'•
•^nd there was set back in proqrarnno imp I ''•mont-.a t i on in
many r.tate.
The same is now renamed as "Community needs assessment approach"
where the Jr.H.A.(p) prepares the estimates or tl ie "omniunity
needs for each services for her subcentre area.
>
The same is
compiled for all subcentres of PHC which will be the community
needs estimate for PHCs for the year.
The Action Plan
will be
prepared for PHC accordingly.
□
Services provided: - Contraceptive Advances A- Services
- Terminal methods/r)erman rit F.!/.methods
- I.E.C. Activities.
4.
Reproductive and Child Health Prograrnme :
The Family Planning Programme was started in 1951 as a
*
purely demographic programme.
oubsequen11 y i-.ho element of public
education and extension wing included to facilitate outcomes under
the Family Planning Programme.
Planning
During the seventies. the Family
Programme was focused mainly on terminal methods and
Programme received set back due to rigid implcmciii.ation of a target
based approach. The Programme has. however, rernained Eully
voluntary and the main effort of Government has been to orovide
services on the one hand and to encourage the citizens
by information.
education and communication on the other hand to use such services.
The experiences gained, within the country and outside, had amply
established that health of women in the reproductive age group
and of small children (upto 5 years of
age) is crucial importance
for effectively tackling the problem of growth o£
oonulotion which
led to change in the approach from Family .’’lanni no to Family Welfare.
-■'•ince the Sev’nth Plan imolemonted during
orograrnmos
have evolved with the focus on the health needs of id
•e women in
reproductive age group and of children below the age "ive years
on one hand and on the other hand to provide
con t r a co n*-. j ve s and
. .6. .
6
s I >a c i ng so r v i co s to the doixous
tbn Homily V/elfare Programme l.or
P?od1o.
11 )Q
rh- m.i i u ob jective of
co’ini.rv li.ir.
1 »• * ■ • r i
1.0 '.I- -)}) | ] i
population at a level consistent with
the needs ol National
development.
2.
The Universal Immunisation Programme (lHP)
aimed at reduc
tion in mortal.ity and morbidity
amonq in Cants and younger child ren
'due to Vaccine Preventable Diseases
was started in 1PD5-B6.
The
Oral Rehylration Therapy (ORT) 'was also start-1
in view the fact
that diarrhoea was a leading cause of deaths
among children.
Various other programmes under Maternal.
an I Ch i id Hon I. th (MCH)
were also implemented during the 7th Plan,
The objectives of
all these programmes were convergent and aimed
at improve!ng
the health of the mothers and young children
and to provide them
facilities for prevention and treatment of
major disease conditions,
Hhile these programmes did have a beneficial ■;
: impact but the
separate identity for each programme was can.'-, ing
or oh l.emn in its
e f fective management and this was also
reducing somewhat the out
come s.
Therefore, in 90's in the Sth Plan, the sc
nrourarnmes were
itegrated under Child Survival and Safe Motherhood
(CSSM) Programme
and which was implemented from 1992-93.
3.
Howe ve r,
the position is'not uniform all over the. country
whereas the State like Kerala, TamilHadu, Goa,
Maharashtra and
Punjab have achieved a considerable higher level.
U.P.,
M.p., Bihar, Rajasthan, J
K.,
the States like
Assam and Orissa are r>orlorming
at levels much below the national levels
This has been a matter
of great concern because these States
al.so happen to be very
populous and unless nerformanee in these
t a ■:e s 1 m pr ove s,
national performance will continue to remain depressed.
the
Ti'.e
results at ground level are influenced by a number
of factors like
investment Cor the programme at Nat.tonal/:;tato
a r i. ic iency
of the «>tate health system and response of
The
de f i.c i 'uir* i.os
i.n
! '.r
1
I
impl'■‘iriotita t ion of
' • 11
the m a b wr ’’ 1
a hi'!
• i
C’’il-1
I .
a I th
i
' ' r i i. ■ I
. .7. .
7
mortality and child/infant mortality and Low health status of
women anJ children.
Poor prospect of health and
life? el
1.1 |Q
children is one of the prominent factors loadim to birth of more
children per family.
various
>
rch
The present position vis-avis to oast levels of
and population indicators is cjiven in the following
table:
ACHIEVEMENTS AMD GO^LS
Indicator
Past levels/achvt .
Current level
Infant Mortality Rate
146 (1951-1961)
72 (1996)
Crude Death Rate
25.1 (1951)
8.9 (1996)
Maternal Mortality Rate
NA
4.37(1992-93)*
Total Fertility Rate
6.1(1951)
3.5 (1993)
Life Expectancy at Birth(Years):
t
1
Male
37.1
(1951)
61.5
(1996)
Female
36.1
(1951)
62.1
(1996)
Crude Birth Rate
40.8
(1951)
27.4
(1996)
Effective Couple Protection
Rate
10..4
(1970-71)
46.5
(1996)
Immunization Status (% Coverage)
.
T.T.
40
(1985-86)
76.73
(1996)
Infant (8CG)
29
(1985-86)
93.1 2
(1996)
Measles
44
(1987-88)
78.91
(1996)
(for pregnant women)
National Family Health Survey 1992-93.
4.
The Approach Paper to the Ninth Plan brought out bv the
Planning Commission has brought out the .i r.adoguacy of th
made for Family Welfare.
i nvestment
This is a severe handicap particularly
when it is noted that in almost all respects.
the health car^ system
needs upgrndation and it needs to reach out to manv more people
for the national goals to be achieved.
While the I-' .i
imorovement due to economic development.
literacy and empowerment of citizens.
steady
snr •ad of ediicar. {.or/
sub.'.t anLa I
: toI '! orns
in
regard to eduoation/1ileracy particularly among tb" weak performing
dtales and jri regard to empowerment.
of
■ /' >';inn,
r"ma in.
8
5.
'1*11<»
<»roc<?ss ol. integration of FQ L.u.
1
’ 'f' > t r • mum's
with the implementation oL: the C3.SPI l’rograniii.e war; r..ifer»
i i liL L-’ii.o 1
.step
further in 1994 when the International Conference on Population
and Development in Cairo recommended that the f>’i r i. i ci nant countries
should implement unified programmes for Reproductive and Child
Health (RCH).
The RCH approach has been defined
"Peonl.e have
the ability to reproduce and regulate tleir fertility. women are
able to go through pregnancy and child birth safely,
the
ou tcome
of pregnancies is successful in terms of maternal and infant
survival and well being and couples are able to I m v'» no x u 11 relations
free of fear of pregnancy and of contracting discases”.
This concept
is in keeping with the evolution of an intnerato'd •innroach to the
programmes aimed at improving the health status of young women and
children which has been going on in the country.
It. is obviously
sensible that integrated RCH Programme xvould help in reducing the
cost of inputs to some extent because overlapping o! '■‘xrrtn l.i ture
would no longer be necessary and integrated implementation would
optimise outcomes at the filed level.
During the 9th Plan, the RCH
Programme, accordingly, integrates all the related programmes of the
8th Plan.
The concept of RCH is to provide
o the Ijonef iciaries
need based client centred demand driven high Quality and integrated
RCH servicos.
'Hie RRXM
RCH Programme is a composite [programme
incorporating the inputs of the Government of India as well as
funding support from external donor agencies including '/orJd dank
and the European Commission.
6.
It is a legitimate right of the citizens to be able to
experience sound Reproductive and Child Health and therefore the
R'^H Programme will seek to provide relevant services
for assuring
Reproductive Child Health to all citizcns.
Pow-'v-’F, :? -|: ir, oven
more relevant Lor obtaining the objective ol si.-.uJ) i..' t’jpu 1-• i.ion Lor
9 :-
)
the country.
The overall objective since the beqinnino has been
that the population of the country should be stabilized at a level
consistent with the requirement of national development.
1
It is now
well established that parents keep the family size small i (j i-.hey are
assured about the health and longevity of the children and there is
no better assurance of good health and longevity of children than
health care for the mothers and for young children.
Therefore, RCH
Programme by ensuring small families also ensures stable population
in the medium and long-term though in the short-term population is
controlled by use of spacing methods and terminal methods for
)
avoiding unwanted pregnancies.
Therefore the overall strategy of
the Government of India (Department of Family Welfare) is to simul-
taneously strive for obtaining Reproductive and Child Health arrangements for the whole of the country's population and to oromote and
make available contraceptive/terminal methods for desirous couples.
It also needs to be observed that the measures through the heal, th
system alone do not and cannot assure success in either ensuring
Reproductive and Child Health or in controlling population.
These objectives are determined concurrently by the following:
i)Policy support expressed publicly by opinion leaders in
different sectors"the national system and by the commu
nity at large. Without this.kind of support;, the rece
ptivity of the people to -make use of even available ■
services cannot be ensured.
ii)Adequate resources for making’ available Reproductive and
Child Health services to all rural and urban communities
in the.country.
>
)
)
iii)Accountability of performance among the health workers
and efficiency of the health system.
T‘l_:
Without
such efficiency
the quality of services to citizens or even effective
access to health services cannot be ensured.
iv)Literacy among women and educational status oF families.
Similarly improvement in economic status of families.
The educated and economically well-of.families can more
rationally assess the options be lore them and acnuire
capabil1ty/willingness to assess consequences or their
present actions for future.
Therefore, the el Fort of the
Department of Family Welfare is to collaborate with the
related departments and Non-Governmental Organisations for
seeking supnort of their Programmes for the family ’’el Fare
Programmes.
This in turn will similarly imnrove the out
comes of related Programmes of those Departments as well.
10
:
10:-
1 hf. htjj Programme Incorporat'*s
• ’< )t■ 11 >r >r v ’til.r;
cnx/r. r ( », I
under the Child ‘Survival and
•■>a Ce Mobhnirihnnd l ’ro* i r niii!i< •aid Indudes two ^d'li.tional
components one relating to onxually transmitted
diseases (3TD)
b
(RTI).
and other relating to ws(pTOiJlir-.i. j Vo
traot inf«Qtion
The main Ihigblights of the -ROKl ffut^jiramiiic
are:
i ) The (^drzajEramme /integrates all Jirrtliat^nt
heal^fnbo?hternal ana chil«^ ions of fertility
with reporudetive
heal
’tih -off
both men and women.
taitn
of both
ii)The r*
provided will lx?
driven, ] •
z
-Ljn quality and based
on tfy
tho no-ds of th------- 1 on
community
arrived
P'-’ning'and^Ae'tZ^t^ree
a^roS^'’’ ’^--—ry
P'nnnim and the ternet free
S^VMgh SuaJltrand^^ "V1
C1,>nt COr'tred
“^for oroJ^""0 enviE^«s umra ling ol
"pnra I j r>n nr II,,. level of f.acIL.ities
Til hirst r2? Var?ous interventions
> and quality of care
n. first Referral Units (FRUs)---h-ino
f sot up at subdistrict level will provide
"
cornnreilonn.i
ve cmerq'.'ncy
obstetric and new-born care.
Similarly
m PHCs will be substantially upgraded' Rd” facilities
iv)The Proppa^ wiu irnr)rove accGs<3 of
community to
o'Zd to Servitres which are commonly ro-mird
and run •r°Vide
^r r-rrn at the p- - • 1t is prop
counsel ling
and mo insertion at SCs in a phased manner
particularly for the vXerlble
°”t-reach of services
have
till
now
subt.nH
iT
u
groups
of copulation who
have till now substantially been left out
of the planning
process e.g.
- Special Programmes will
taken up for
Orban slums. tribal, popul.arion arrJ
Adolescents.
Non ^vernmental Organisations will he .
involved in a much larger way to improve
reach ani make it peonlc’s oroeramme.
practitioners of 7".......
development in
~ , .i the range of
.refe2rc^ anf^
rot s9“J1S.:up,”rt"1 to
Panchayati Raj System will bavn a nr^;l|r.r
role m planning, irnnlementnti on arrl
assessment cE client satisiaction
PROGRAMME
7.
ItTTCRV£MTlOH3.
The RCH
approach.
programme will be implemented base-1
Tnputr, in all the Districts
becuase efficient delivery will depend
I la v *
on differential
r’oi
n i f orm
on the capalii .1 i ty of
.
tl ip
11
11
health system in the District.
The re Lore,
I >ai r; I ac i L i. I i.es a re
proposed to lx^ strengthened and streaml 1 nod sjyac i
i
1 >y
I. ri
i.Iiq
weaker Districts as the better districts already have such faci
lities and the more sophisticated facilities
proposed the
relatively advanced Districts which Have acquired the capabilitv
V
to make use of them effective.
All the Distri.cts have been cate —
gorised into categories A (58),
B (184) and C (2.65) on the basis
of Crude Birth Rate and Female Literacy Rate which reasonably
represent the RCH status of the District.
a
covered in a phased manner over three years,
The nationally uniform
and differentiated RCH,interventions would lx? as below:
INTERVENTIONS IN ALL DISTRICTS
IMVER'’EinT'’d.IS IN SELECTED
STATES/' H S'N’ ICTS
Child Survival interventions
(as available under CSSM
Programme)
Screening and treatment of
RTI/ST1
t
* oafe Mother hood interventions
(as under CSSM programme)
A
The districts will be
facilitation for operationa
lisation of Target Free
Approach
Institutional Develofxiient
★ Integrated training package
Modified Management Informa
tion System
* I“jC activities
counselling
on health sexuality & gender
* Urban
Tribal Areas RCH
package
District Sub-projects under
Local Capacity Enhancement
* RPI/Sri Clinics at District
Hospitals (Where not
available)
* Emergency Obstetric Care at
selected FRUs by providing Drugs.
r Essential Obstetric Care by
providing Drugs and HTi/Staff
Nurse at PHCs
’■ Additional ANii at sul">—centres in
the selected districts for
ensuring MCH care
Imoroved delivery services and
emergency care by providing
Equipment kits, IND insertions
• and ANN kits at sub—centres
* Rental to contracted '•HNs/AllMs
not [provided Government
accommodation
★ Facility of Referral transport
for pregnant women’s.
Facility for Safe abortions
at PHCs by nrovi.ding equip
ments, contractual Doctors etc.,
)
* Enhanced community partici
pation through Panchayats.
’’omen’s Groups and NGOs
Minor civil works
Provision for Lab.Technicians Cor
laboratory diagnosis of RTI/STI
DOC
* Adolescent health and reproductive
I iyo i r'no
1 2.
12
5. Nnt.iotinl
t.H
ntrol Proqra nunc?:
Tuberculosis is a major public health problem in India
contributing J,5th of: the global burden.
12-14 million people
cifo estimated to be sufferring from active disease
of which
3
3.5 million are highly infectious .
AS f>cr the National
Survey conducted during
1955-58, by the Indian Council of
Medical Pesearch to findout the rnaqnitudo of
the T.B. oroblorn
in the country, it revealed that Tuberculosis
is prevalent
throughout length and breadth of
country ngually ir< urban and
rural areas.
2% of the population is sufferinq L’rom pulmonary
Tuberculosis of which 0.4%
are sputum positives.
The National T.B. Control Programme
was evolved in 1962
on the findings of above
study and in Karnataka the programme
is in operation from 1962.
Objectives:-
To reduce the Tuberculosis in the community to that
level when it ceases to be a public heal th problem
by:
i)J3etection oC Tuberculosis cases el
attending the OPD
and providing effective treatment.
ii)ro reduce morbidity and mortality due to Tn.
in)To break the chain of -transmission in. the
Implementationt -
community.
The Joint Director, TD is responsible for
implementation of programme in the State.
At
l:.l i' *
Hrj-. rich level
the District Tuberculosis Officer is responsible
bar implementation
in the District throuqh the network of iH.Vi.tl, .,n 1 iH!i/;r,l mstiiutlo.
in the Districts.
The infrastructure facilities created under
thi s programme are as follows:
1. District T.B. Centres - 27
2 . Add! ./list.T.B. Centres- 5
3 . microscopic Centres - 805
4 . ■:-p.a y Contres - 172
5. 'Inferring Centres - 840
of Patioii.il
1
r
to l'?07-9.g i s given i n tl
i *
. ni • •
r
1? I
..13..
13 : 6 . N3tion.il Leprosy eradication Programme:
The Leprosy Control Programme is in operation since 1955
as a centrally aided programme to achieve the control of leprosy
through early detection of leprosy cases and DDS monotherapy.
During the Fifth Five year plan. it was made as centrally sponsored
programme.
>
In 1980, the Government of India resolved to eradicate
leprosy by 2000 AD.
As per recommendation of working group report
of 1982, the National Leprosy Control Programme was redesignated
as National Leprosy Eradication Programme with revised strategy
based on the Multidrug therapy with goal of eradicating the
disease by 2000 AD.
Strategy:-
NLEP operation as a vertical programme in endemic areas
and in areas with prevalence of less than 5 per 1000 population
it will be provided by the
general health services.
The revised strategy is based on:
1. Early detection of cases (By Population Survey,
School Surveys, Contact Examination and voluntary
referral).
2 . Short term Multidrug therapy.
3. Health Education and rehabilitation activities..
The WHO regrness was adopted for treatment.
In Karnataka
the Leprosy was evidencies in districts of Gulbarga Division,
Belgaum, Dharwad and Bijapur Districts in Pelgaurn Division.
Mysore District in Mysore Division.
MOT programme was implemented
in the State since 1985—86 onwards.
The infrastructure created under the programme are as
follows:
State level programme Officer
I
1.
2.
3.
4.
3 .L .0 .
- 1
S.S.A. Units
D.L.O. - 18
L.C.U. - 31
5. S.E.T. - 677
is the Joint Director (Leprosy)
4
1.4
14
6. P.h.C. - 49
7. T.H.W. - 22
8. R.S.U. - 6
9. L. R.P.U.- 2 4-1
10. M. L.C.U.- 14
11 . M . L . T. U. - 14
12. V.O.L. - 25
The revised objective is to Hztx eliminate the Leprosy by
2000AD by bringdown the prevalance of Leprosy to less than 1 per
10000 population by implementing tbe revised strategy.
The progress of the programme implementation is given
in
the Annexure appended.
7 . National Programme for Contro1
of Blindness (NPCB):
This programme was launched in 1976, incorporating the
th
earlier Tragpme Control Programme which was started in 1968.
The National goal is to reduce the blindness in the country from
1.4% to 0.3% by 2000AD and to provide comprehensive Eye Care
through Primary Health Care.
The catract cases constitute 55%
^of the total blindness in the country.
This programme activities
are mainly providing services by. organising Eye Camps in the
Rural areas for cataract cases.
■Mobile Opthalmic units are
providing the services in the State.
these mobile opthalmic units.
this programme.
All the districts are having
Danida is providing assistance to
District Blindness Society is functioning in
every District under the Chairmanship of Deputy Commissioner
which is responsible for organising the services and
providing
material support.
The Joint Director (Opthalmology) heads the State Opthalmic
Cell who is responsible for implementation of
programme in the
State. This is a 100% Centrally sponsored
programme.
. . .15. . .
2^1
0 . Iodine Deficiency Disorders
(IDP) Programme:
The Goitre control programme
was started in 1962. ba se d
on iodized salt.
In Karnataka also the Districts of Chlkkamagalur
and Kodagu
are effected more compared to other districts.
The programme is implemented
all over the State.
has banned sale of non-iodized
salt.
9. National AIDS Control
7
Government
Programme:
It is new programme and launched by
Government of India
with World Bank Assistance being 100%
centrally sponsored
programme.
The State AIDS Cell’ is r^npono l.bl o
f f)r plannl.nrj,
implementing and monitoring of -programme activities as
per
guidelines of NACO. Additional Director
level programme officer in the AIDS
shed during May 1992.
(AiD.q)
is the State
Cell which has been establi- ,
The AIDS Surveillance Centre
was started
at BMC Bangalore in 1987.
I
Components of the Programme;
1) Programme Management - State Aids Cell
- Empowered Committee
2) .Surveilance and Clinical..Management ■/..
■
t. i». i |
3) Blood safety
facility
■ -
-Modernisation of Blood. .Henks
'
t
•’r
4
■ ->,?■■■
-w?:-
- Zonal Blood Testing Centres
4)STD Control Programme
SiTraining Programme
-
- . 6)1 E.C.
......
'-'SpI Spiteg
■
BII
L
.aes'agsaaiM
t?
h’s •■■■
!h®I ®
fe '
fclI i;jhB
b
' - k fe.
fill
hi| «
0
g' '4^
-
? i!®IH
‘
’ 1 <• . ■ ■'--4i^^h-fAnanciaily...sup^ct0d?-S2O^^
$■
w
sfe
Non-financially supported
hs. %>•u^-
■H"
iOtOWS -9
- 15
..16..
i
I ‘Bw
16
HIV Infection and AIDS cases reported in Karnataka upto end
of May 98.
1.
2.
3.
4.
Total No.of samples screened for HIV
388586
No. HIV +ve confirmed - 3973
Sero positive rate - 10.22 per 1000 tested.
No.of Aids cases reported
139
In Karnataka - 127
Diseases Control Programme:
During the Sixth Plan, the National Diarrhoeal Diseases
Programme was started to bring down the
mortality due to
<^^arrboeal related diseases (including cholera)
through promotion
of Oral Rehydration Therapy, This programme was intensified
during Seventh Plan to reduce the mortality due to diarrhoea
by 50% by the year 2000. This programme is integrated with
Primary Health Care at village level to District
Hospital level.
O.R.S. pockets are. supplied
to subcentres and Village Health
Guides. Another important component is
Health Education and
Health Education materials title "Home Treatment of Diarrhoea"
in Local/Regional Language is
supplied to PHCs^ for free distri
bution.
STD Control Programme;
T
In 1949 the programme was started as a pilot project
for control of venereal diseases. In 1955z the planning
commission recommended for establishment of one VD Clinic
in every District Hospital and one Headquarter
Clinic and
Laboratory in every State.
The programme was started in 1957 by settingup of
a Central V.D. Organisation in the Directorate General of
Health Services for implementing and Co-ordination of programme
in the country. Injection Pencillin (PAM) and
VORL Antioen
were supplied free to VD clinics.
The Government of India
discontinuxed
the free supply of drugs to States during 1981-82
. .17..
I
?)(?3
17 : -
and strategy was focussed on training,
toaching and research
in the various aspects of S.T.D. Training Centres established
are as follows:
Dlnstitute for study of V.D. 1Madras, Medical College.
2)STD Training and
■ Demonstration Centre,
Safdarjang Hospital, New Delhi and^other
--- j two centres
for remaining areas are at Calcutta
other at Nagpur.
With appearance of AIDS, the problem has changed its dimension.
Stress has been given for STD control in the
AIDS Control Programme
as a component.
In Karnataka 30 STD Clinics are functioning.
Rupees One lakh drugs are supplied to each for
free treatment
of S.T.D. cases.
Guinea-Worm Eradication Programme:
The Government of India launched the Guineaworm Eradication Programme in 1983-84 during Sixth Five year Plan after
>
recognising it as a public health problem.
sponsored programme (50 : 50:).
the programme was made in 1985.
This is centrally
In Independant Appraisal of
’As
on January 1986,
Six States
were endemic affecting 7114 villages, in 481 PHCs and 66 Districts
in the country. The Tamilnadu State
vigorously Implemented
the programme before National
Programme began and no ind ig.eneous
cases since 1981.
1
Programme components/Strateqy:1) Providing of drinking water sources on priority basis.
2) Vector Control with application of Abate (Tempohos)
giving concentration of Img per litre (IPPM)
3) Health Education including Personal prophylaxis
le., Soiling of drinking Water , Sieving of unprotected
water.
>
4) Supply of Nylon mesh filters..
5) Active Surveillance of cash twice yearly.
This programme is implemented by the
Primary Health Caro
4
staff.
The goal is to eradicate the disease in all affected
areas.
)
The programme input was only one cell
at Directorate
in CMD section to monitor the impliment.ation
and xra evaluate
the activities. The searches v/ere carriedout
twice y^^arl. v
. . lp. .
18
usually in 0QCOn^)er and June
every year.
riistr.icts of Oulbarga Division Rijapur,
Tn Karnataka the
Of in rwa d v/e re a (? fnot-.nd .
Due to implementation of above
programme there arc no indiqdneous
cases in these area since last three
years. Actions are taken
for preparing the areas for WHO Certification.
The Award ot Rs. 100/to the informer and Rs.500/- for case for treatment
purnose. The
suspected reported should be investigated
reported by PHC Medical
Officer and documented for the verification
team.
1
Minimum Needs Programme:
It was introduced in Fifth Five Year
Plan. Tl»is programme
aims for improving the living standards
oE the peoole by providing
certain basic minimum needs. This is commitment
oE Government
for the Social and Economic Development
of people, yoartHK particularly
for under privileged and under served
population.
Component s: DRural Health '
2) Rural Water Supply
3) Rural Electrification
4) Elementary education
5) Adult Education
6) Nutrition
7) Environmental improvement of slums
8) Houses for landless labourers.
Rural Health:
As per objectives o.f Seventh
Five year plan to
establish. one PHC for
every 30000 population in plain and 20000
population in tribxal and hilly areas;
one subcentre for every
5000 population in Plain areas and 3000
population in tribal
and hilly areas and one
community health centre for every 1 lakh
population by the year 2000AD.
Accordingly the State Government has been
establishing
the Subcentres, PHCs and CHCs in the
State.
. . io..
%
19
)
National Diabetic Contro1 Programme:
Objectives:1) Identification of high risk subjects at an early
stage and imparting appropriate Health education.
2) Early diagnosis and management of cases
3) Prevention, arrest, slowing of acute metabolic
as well as chronic cardiovascular complications of
diabetics.
«>
The Programme functions at three levels.
1)Subcentre, '’2)PHCs and (3)District Hospital.
Government of Karnataka has sanctioned this scheme to Hassan
and Dakshina Kannada Districts.
Training has been given to
Medical and Paramedical staff and Mannuals of the programme is
)
translated in Kannada and printed and supplied
to all institutions.
The equipments and materials are provided.
Cancer Control Programme:
*
Government of India has financed the Kidwai Memorial
Institute of oncology to takeup the Cancer Control Programme
in the StaLe for taking activities.
-
1)District Cancer Control Programme:
—....................................................................................................................................... ..
.......................
- ■
———.
The District Cancer Control Programme is sanctioned to
Dharwad and Chikkarnaqalur Districts in the eighth Five year plan.
The activities carried (l)Survey of cancer cases, diagnosed and
treated (2)Health education activities.
The programme is sanctioned
for five years.
2)Peripheral Cancer Centres:
Peripheral Cancer Centres are sanctioned and established
at District Hospital, Gulbarga and"Mandya and entirely managed by
the Kidwai Memorial Institute of Oncology, Bangalore where
diagnostic and treatment'facilities are provided.
)
)
NATIONAL LEPROSY ERADICATION PROGRAMME
SI.No.
Year
Cases on han'l
1.
1993-94
24542
2.
1994-95
21067
3.
1995-96
18615
4.
1996-97
17766
5.
1997-98
12019
NATIONAL TUBERCULOSIS CONTROL PROGRAMME
SI .No
K
Year
Case detected
1.
1993-94
67790
2O
1994-95
76819
3.
1995-96
P.3244
4.
1996-97
81785
5.
1997-98
79984
7^,
DIRECTORATE OP E^ALTH nD FAM III KSLFAH3 STR VI CBS, EA55AX0RS
C.M.D. Section
INCTDglCE OP COMMUHCA5LE DISEASES in Karnataka State ^rco 193$ to 1°?7
i
GASIRCE’-TS^I J
D
A
VIRAL
TTPHOID
hepatitis
CHOLERA
A
D
A
JAPAKBSB
KN CEPHALITIS
D
D
A
1
i
GJIIIEA
WORM
K.F.D.
A
D
A
D
A
PLAGUB
D
A
D
399
.51
DENGUE
FEVER
A
9 37 6
370
1212
59
354
9
635
18 5
780
14
Z7 54
S845
503
1918
87
945
8
. 132
43
223
10
240 5
1108 5
645
2263
72
190
8
81
27
312
6
1939
9918
418
7 67
26
339
10
49
18
1530
22
896
8565
391
448
15
18 29
28
130
43
1309
31
634
17 465
631
747
15
659
17 .
308
114
967
16
226
15262
638
402
14
282
17
58
15
1183
5
167
3633 6
8 55’
424
13
78 6
7
26347
287
67
699
3
29
15932
325
334
10 ’
639
3
30349
125
47
110
18 645
396
532
8
714
1
10250
-
329
102
174
3
72
22^3
377
657
6
1332
6
22221
_ 12
127.
17
140
3
93
23665
336
741
10
1714
4
3880
5
407
85
75
4
4
J 1
10
LEPTOSPIROSIS
D
A
D
67
2
3
^:c.
13
----------------------lA2a?21\
1
I
I
I
1
1
1
!
i
I-
■LL'aiTj TP 1
65,92,165
63 ..54,573
.-7,559
-'6,02.434
l^laria
cases
79,98,519
12,997
,22.838
,32.302
j c olid
a
T?--^
______ j _____ J.3.
1
-^1 cases
----- !1
i
-'^3 tgc-ad
cnlimeG
da^ected
rate) .
---------------- I1
A
A
D
D
— — — ->1 __ _
57,co?
1,06 ,'260
29,659
1,02,222
35,923
2352
5.3%;
i,i7,cce ;
92,24?
507?
5 .5p!
I
1,01,513
2441
I
I
I
I
I
I
I
I
I
I
I
I
I
I
1
25,209
70,055
}
97,197
2205
2.2::-{
10,155
45,450
'
1,02,457
81,057
1359
16,326
'65,200
!
1,19,316
1»9c , 460
1620
1.5:-1
l.35i
49,246
1,90,514
j
1,57,606
1520
1.1" j 28?
37,789
2,57,553
□7
1,56,325
980
o.^l 125
~7
-,22,484
964
102
23
1,55,469
10 ;>
0.32; 529
O.cjil 12?
7
44
2,66,679
2,55,350
2,19,196
22,659
Dea-zs
I
1,27,008
74,012
i-siizA
1 ~
—J
-JU. COG
-reatzent
29,580
1,31,450
:,364
al
cases
38,505
66,45,525
69,23.592
;
1777
59,501
52,5c6
•■^,326
5,571
1,30,976
I
'20,?eq
|
2,79,555
2,16,127
1
I
2,08,327
52,264
I
0.6,7; 407
20
2
I
I
I
I
I
I
I
I
I
I
I
I
I
i
I
I
I
I
I
I
I
l_
575
3
212
123
195
252
i
?
An':.g '; r ’
CONDUCTION OP TRAINING PROGHAWE AT PNC & SC.
l'
7 C
The Quality of health care services is directly
related to the competencies of the health functionaries in
providing these services, their service competencies need to be
t
augmented by Training, to join in the main flow of health services
and also to update their knowledge and skill for favourable attitude
a nd motivation to perform their jobs in an efficient and effective
ma nner. So training is essential and vital. It helps in orientation,
updating the knowledge and motivating them to become more positive,
constructive ahd productive.
Even after joining the service they are not in
touch with acedemic activities. So there are serious ga ps in the
knowledge, skills ahd practices of the health personnels specially
in regards to family planning, maternal and child health, nutrition,
irnmuni sat ion,
environmental
control of communicable diseases,
sanitation, vita.l statistics and health education. This has made
an urgent need for training of all ca.tegorjfes of health personnels
now and ‘then during their service.
)
Training -give instructions or information or practice to make
skilled, and it is
per.sons more knowledged and
r
a]_way s re ci pro cal.
Programme - plan of intedcd proceeding
- list of planned events.
( Greek: progra.mma
public notice )
Programme is always a. planned, one.
Primary Health Centre - place from where the Primary Health. Care
is provided to the community.
Before Alma-Ata Conference the Priimnry Health Care
)
means - basic health services
first contact cere
-cosily accessible core
"I 1 tr
TyT'cwri Horl
cp-rvi nep,.
■*“
-au.
2
A .f 't' o p A T ™ P — A -^r-
Conferonce the Primnry Health
Care
means-'’Essential health
core mode
to all individuals and
vnivorsolly nccesoi,
ccceptcblc +0 t h cm f
tbroumh. their fvl] P''’i’ticipa.tion
nnd at a cost
that the community -nd the
country con afford."
Befepe
conduction of training the
following points are
to be
considered in detail
as preperation.
Cats
train e e s
- T.B.A.
“ V.H.g.
- A\7\7.
“ Medical
-
or Para.medical health
Personnel.
S. 3. members.
Social workers.
- Link workers.
•school teachers.
- 'T • C. 0 • s
Panchayat raj -members.
IT.
cfivesof training
~ Update their knowledg
e> skills fc practice.
- Aware of their job
responsibilities.
- Regular recording’ and reporting.
Prepare them as trainers to
III. 'types of training -
community.
induction
in-service
or
-yearly
- seasonally
random
l£Tr,’P “ Primary Health Centre
- Sub-centre
Community con tre
i
4
There should be feedback,
through- impressions ft suggestions
on- coarse contents
~ at the time of tea,lunch
~ teaching method
~ at the end of training
- handouts
- Ofrp / slide Projector
"-■^ggestions to improve,
VI. Curricuium once finalised,
should be distributed to teaching
faculty and guest Speakers well in advance
and request to
give summery and important handouts
to be distributed to the
tra.inees.
)
~~
E££^icipants, gue_st lecturers and fjeld staff
where
you are giving field training, should be identified,
local or withi^aluka
-
----- —-------------------
preferabl
Parti cipants and guest lecturers
must be informed well in time
preferably 4-6 weeks in advance. It should
not be too early,
^0 that by the time the training dates
approaching it should
not be forgotten.
11 • Training_ mete_rial s
- Black board
chalk pieces & duster
- Charts & tables
- Diagrams
/CP with casettes
O.H.P.
Slide projector
Dpidie scope
Demonstration meterials - B. P. spparatns/s^bUcc^t
- Thermometer
- Gloves
- Autoclaver / Pressure cooker
)
- Scissor / Blade
- Delivery kits
V* Curriculum - based on category and contents, should be prepared
before t raini ng
- Cover all the topics mentioned in the contents of the
training.
- Each topic (for example-immunization)
- what are the facts-important (schedule,
cold chain, reactions)
- how much details should, trainee needs
(hepatitis vaccine-details etc.)
- standard of performance.
and also - certain things -must
- useful
nice
Make sure that the trainees are learning, but not just hearing.
For this keep in mind
-Clearity- simple language, community based
-Veriety- makes learning interesting
-Participation - practical demonstration
- hands on practice
(Chinese proverb
H
if I hear I forget
I see I remember
I do I understand
H
So training should be through,
- lectures.
- practical demonstration.
- hands on practice.
- role play, songs.
- group discussion.
games, problem solving, case study.
field demonstration.
should ba -f-
■dhaok^
4
IX. Budget.
T. A. & D.A.
- Contingency
Guest lecturers/ Speaker's remuneration
POL
the diplomacy to mobilise resources
teamleader(lvl.O.)may
have
The
all these you are ready to start
After having prepared
not possible to remember every
the training programme. Now it is
of the programme. So it is always better
thing by the co-odinator
to have the check-list.
classroom
Check-list - Arrangements - hospital
field
- Faculty according
to timetable - P.H.C-r
- C-uest speakers
- Training materials*
v/ith driver & fuel.
- Vehicle in good condition
- Field staff.
accoino dation
Probl ems: a)Managerial - food
- faculty members
- Office work
- Copying & distribution of
back-ground meterials
Finance
b)Technical - electricity
— demonstration of instruments
vehicle
c) Field -
community leaders specialby
the
ac c eptabiliJV
women leaders &
field training.
+ + -V + + + -V + ’* ■ + + 4’
family heads at the time of
- Media
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