INDUCTION TRAINING PROGRAMME UNDER EXTENDED RCH PROGRAMME FOR MEDICAL OFFICERS OF PHUS / PHCs
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INDUCTION TRAINING PROGRAMME UNDER
EXTENDED RCH PROGRAMME FOR MEDICAL
OFFICERS OF PHUS / PHCs
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II
INDUCTION TRAINING PROGRAMME UNDER
EXTENDED RCH PROGRAMME FOR MEDICAL
OFFICERS OF PHUS / PHCs
LITERATURE UPDATE
■>
By
STATE INSTITUTE OF HEALTH & FAMILY WELFARE,
MAGAP1 ROAD, BANGALORE - 560 023
4
INDEX
SI.
No.
Topic
1.
Introduction to Training to Newly
Appointed Governmentdoctors
Organisational set up and functions of
Health and F.W.Department and Powers
of Taluk Level Health officers.
National Malaria Eradication programme
and National Filaria Control Programme
in Karnataka.
National AIDS Control Programme in
Karnataka.
National Tuberculosis for Control
Programme in Karnataka.
National Programme for Control of
Blindness in Karnataka.
National Leprosy Eradication Programme
in Karnataka.
School Health Services.
2.
3.
4.
Name of Speaker / Contributor
Dr. K.B. Makapur
Director, SIHFW
Dr. K.B. Makapur
Director, SIHFW
Dr. M.V. Murugendrappa
Joint Director (M & F)
Dr. P.N. Halagi
Additional Director (AIDS)
5.
Dr. H.G. Narayana Murthy
I/c Joint Director Ophtholmology)
6.
Dr. H.G. Nookapur
Joint Director (Ophtholmology)
7.
Dr. S.M. Jungay
Joint Director (Leprosy)
8.
Dr. Jayadeva
Joint Director (HET)
9.
Integrated Child Development Services
Dr. Jalaja Sundaram
(ICDS) Scheme.
Deputy Director (Nutrition)
10. Information, Education and
Smt. HS. Susheela
Communication (IEC)
Joint Director (IEC)
11. Obstetric Emergencies
Dr. Jahnavi V. Kumar
Deputy Director, SIHFW
12. Management of Drugs.
Dr. Bevanoor
Joint Director (GMS)
•j
13. Epidemiology ;of Diseases and Epidemic
Dr. M.K. Sudarshan
Act 1897.
Prof, of Community Medicine,
KIMS, Bangalore
14. Reproductive and Child Health Services
Dr. G.V. Nagaraj
(RCH)
Project Director (RCH)
15. Medico Legal Procedures.
Dr. L. Thirunavakkarasu
Prof, of Forensic Medicine, BMC,
Bangalore
16. Community Needs Assessment Approach
Sri. G. Prakasham
under RCH in Karnataka.
/ Demographer
17. Doctor, Consumer Protection and
Dr-^S. V. Joga Rao
Adjudication of Liability.
AddPProf. of National Law
School of India University
Page No.
1
1-9
10-13
,14-17
18-19
20-22
23-27
28-30
31-37
38-39
40-48
49-57
58-60
61-76
77-92
93-96
97-107
SI.
No.
Topic
18.
Karnataka Health Systems Development
Project - Access to Women’s Health and
Referral Protocols.
National Health Programmes, their
Objectives and Implementation
Responsibility of Drawing and Disbursing
Officers.
I
Hospital Cleanliness and Waste
Management
Health Management Information System
19.
20.
21.
22.
23.
24.
Management Concepts, Principles,
Functions, Applications in Health
Management
Departmental Enquiries
25.
Conducting of Training Programme at
PHC & Sub-Centres
26.
Synaptic Notes on Retirement Benefits &
TA Rules.
India Population Projects in Karnataka
27.
28. KCS Rules - Recruitment, Probation,
29.
Seniority, Promotion.
Yellow Card Scheme - A Scheme for
Providing Better Access to SC/ST
Population.
30.
Name of Speaker / Contributor
Page No.
Dr. G.V. Vijayalakshmi,
Consultant, KHSDP,
Bangalore
Dr. K.B. Makapur
Director, SIHFW
Dr. K. Mruthunjaya Swamy
Faculty, ATI, Mysore
Dr. H.R. Sathyanarayana
Consultant, KHSDP, Bangalore
Sri. G. Prakasham
Joint Director, Demography
DH & FWS
Dr. Kishore Murthy
108-134
Sri. K.R. Srinivas
CAO, KHSDP, Bangalore
Dr. Koradhanya Math
Asst. Training Officer, IPP-IX (K),
Bangalore
Sri. Viswanatha
CAO cum FA, DH & FWS
Dr. K.B. Makapur
Director, SIHFW
Sri. P. Ramanathan
Consultant, DP AR
Dr. HR. Sathyanarayana,
Consultant, KHSDP, Bangalore
*
135-148
149-157
158-160
161-163
164-181
182-185
186-189
190-202
203-209
210-227 ■
228-234
235-247
Tterslrtsb
D
31.
248-270
32. Duties and Responsibilities of Junior and
271-274
Senior Pharmacists.
7
.NTRODUCT.ON TO TRAMNC TO NEWLY APPOINTED government doctors
K-B- Makapur, Director, SIHFW
------------------ ----------------- ---------------------
aware o f the organisational set up of Depitment at tario 7 T f° d°CtOrS t0
them
Centre Level and various activities to be^amed ont °^.levels from State Level to Sub•mplementation of various National Health and Fam 1f"8 PDr°Vldlng of Medical Care,
and Administrative responsibilities of^edicXffTe ^“d Financial
the PHC/Department. The Induction Training is most n d d f S °r eiFective functioning of
their smooth and effective functioning.
°
ostneeded for newly appointed doctors for
Objectives of Training:
and Famlly'wdfSr°f Health
role/responsibilities as a Medical Officer of PHC/PHU.
b'Centre level and their
respoSifies orMe^ic^Xmers^Ioll^c^^’ J™11"211 and Management
33 t0 Carry out smoothly the functions of
Medical Officer
5.
6- To onent
procurement of drugs, chemicals etc., required for the PHCs.
D— -
Org’”iSa'“ "P “SSS
11 iS
State Government to^SealfS* C^etcilif
*
’
- -
responsibility of
the above responsibilities, the State Government haTset
tT733 ,Accordingly, to fblfill
guidelines of Government of India and upgraded the facilif hS J?53 th
faciIities on the
to time to provide comprehensive Health Care facififi^ T'c
'
neW facilities time
Family Welfare Programmes are also implemented as nS ' T' ?h" Natlonal Health and
for prevention and control of Communicable Diseases ' c ld.e’1?es.of Govemment of India
Leprosy, Gustroenterics/Cholera and other vaccine
IZFilaria’ Tuberculosis,
Communicahie Diseases like lodme detierSsoTrn K ,
implemented in the State.
7
C0°,r01 °f N»"-
order, Diabetes, Cancer, etc., are also
The following Health Care Services are provided by Government in the State.
1. Promotive Health Care Services.
2. Prevention and Control of Diseases.
3. Curative Services
1
4. Rehabilitative Health Care Services.
To provide comprehensive Health Care Services the State has created and providing
services at the following levels :
Primary Health Care Services
At Sub-centre, PHC & PHU.
Secondary Health Care Services
CHC, Taluka Level, Hospital and District
Hospitals.
Tertiary Health Care Services
Major Hospitals, Super Speciality Hospitals,
Teaching Hospitals.
Sub-Centres:
There are lowest level Health Care facilities, headed by a Junior Health Assistant
(Family) for every 5,000 population in the pain areas and 3,000 population in the hilly and
tribal areas. These sub-centres provide Primary Health Care Services including RCH ..
services. A total of 8,143 Sub-Centres are established in the State as on 31-03-1999. These
Sub-Centres activities are supervised and managed by the Medical Officer o f PHC/PHU.
Primary Health Centres:
These Centres are providing Promotive, Preventive and Curative Health Care
Services. One PHC is established for every 30,000 population in Plain areas, 20,000
population in the Hilly and Tribal areas to provide Primary Health Care Services, headed by
Medical Officer assisted by Paramedical Personnel. A total of 1,601 PHCs are sanctioned
and established in the State as on 31-03-1999. These Centres also implement the National
Health and Family Welfare Programmes. (PHU were established in the State to provide
Primary Health Care Services in the smaller areas and these are being upgraded to PHCs as
per norms).
Community Health Centres :
These Centres are established by upgrading one PHC out of four PHCs to function as
first referral unit for population of one lakh, for providing diagnostic and treatment facilities
and 30 beds for providing Curative Services as inpatients. Four Speciality Services are
proposed to be provided.
The Director of Health and Family Welfare Services is the Head of the Department
and responsible for the Planning, Implementation and Monitoring of all Health Care Services
in the State. He is assisted by the Chief Administrative Officer , Chief Accounts Officer cum
Financial Advisor and Additional Directors and Joint Directors Implementing the National
Health and Family Welfare Programmes.
Divisional Level Organisation :
The Joint Director Head of the Office, the four Divisional Offices are functioning at
four (04) Divisional Head Quarters with supportive Staff
1
District Level Organisation :
The District Health and Family Welfare Officer is the Hend nf Of-rro •
^me^^^
“ District Level.
controlled
by Zilla Panchayat at
A0=“d
:ers.
Taluka Level Organisation :
?31th °fflCer P°St iS sanctioned for each Taluka to plan implement
monitor, the Health Care activities in the Taluka area, who will be Supervising and
with othe’rDeX'eT °f
“ "" T*1"l‘a “d
Cities of Department
Below Taluka Level :
rnmi o Pnmary Heal,th Care
established to provide Primary Health Care Services in the
NationafHeSh imd F
wV'8 pSub'Centres for carrying out the implementation of .
cXeX
Programme in addition to providing of Primary Health -
Sub-Centre :
M ui,
iS J® 10WeSt PeriPheral Health Organisation established f
for providing Primary
ProgrLLTs tafc“d
VI.
Welfare RCH)
The chart showing the organisational set up of Department is given in Annexure I to
The Administrative and Financial Powers of Taluka Level Health Officers is appended.
1.
2.
3.
4.
Surgery
Obstetrics and Gynaecology
Paediatrics
Dental Care Services.
District Hospitals:
Xt’XXXXTXXX
3
0^Health
State Headquarter:
Minister for Health and Family Welfare heads of Departments and Secretary to
Government, Health and Family Welfare Department works under the Minister. The Medical
Education was one of the wings of Health and Family Welfare Department earlier, now it is a
separate Department with Minister and Secretary.
There Departments work under the control of Health Secretary :
1. Directorate of Health and Family Welfare Services.
2. Directorate of Indian System of Medicine.
3. Drugs Controller.
Directorate of Health and Family Welfare Services :
Earlier Director of Health and Family Welfare Services was head of the Department
and was working under the Health Secretary. Now during May 1999 a post of Commissioner
for Health (in cadre of Secretary to Government) has been created and filledup, who will be "
co-ordinating the activities of all the wings of Directorate and looks after the policy matter.
KARNATAKA
Demographic Scene at a Glance
01.
Karnataka is one of the 8th Major State in India.
02.
Geographical area
- 1.92 Lakhs Sq. Kms.
03.
Projected Population
- 05 Crores
04.
No. of Revenue Divisions
-04
05.
No. of Districts
-20 + 07 New Districts
06.
Taluks
- 175
07.
Urban Population
- 2.40 Crores
08.
Rural Population
-3.10 Crores
09.
Male
-2.30 Crores
10.
Female
- 2.20 Crores
11.
Sex Ratio
- 960 Female / 1000 Males
4
L
Health Institutions in Karnataka
01.
Total No. of Health Institute
02.
Total Bed Strength
03.
Teaching Hospitals
04.
No. of District Hospitals
05.
No. of Hospitals 50-100 beds
06.
No. of Community Health Centres
07.
-2,336
-38505
- 17
-20 + 07
-52
-242
No. of Primary Health Centres (GOIP 262 + - 1601
MNP 1332)
08.
No. of Primary Health Units
09.
No. of Sub-Centres
10.
No. of Maternity Annexes
11.
Population Bed Ratio
-589
-8143
-279
- 1428 / 1000 Population
Demographic Para - Meter
01.
Annual Growth Rate
02.
Decimal Growth Rate
03.
Birth Rate
04.
Crude Birth Rate
05.
I.M.R.
06.
M.M.R.
07.
Reproductive age group (F)
08.
Life Expectancy 3/4 Male
09.
Life Expectancy 3/4 Female
10.
Mean age of Marriage of Girls
- 1.9%
-21.11%
-23
-7.3
-53
-4.5
-15-29 Yrs.
- 65-55 Yrs.
- 66-55 Yrs.
- 19.4 Yrs.
Beds Distributed in Health Institutions
District Hospital
250 to 750 - 2 Million
Taluka Hospital
j0 to 100 and above
Community Health Centres
30 to 50 beds
Primary Health Centres
06 '
Population Bed Ratio
1.428 / 1000 populaiton
5
Mysore Type of Dispensary / PHU
: 589
Population
: 15,000
Cost
: 6 Lakhs
Sanction of Primary Health Units stopped since 1984
Z
!/
6
ANNEXUREI
Organisational Set up of Health & Family Welfare Department
Secretariat Level
Minister of Health & Family Welfare
■
Government of Karnataka
T
________ I
1IFA
Deputy Secretary (Health)
Under
Secretary
Services
▼
Under
Secretary
C&R
▼
Under
Secretary
R&I
Under
Secretary
Health
▼
Under
Secretary
ISM
T
Under
Secretary
Legal Cell
ANNEXURE II
Secretary to Government
Health & Family Welfare Department
▼
Director
ISM
V
Drugs
Controller
4
▼
Commissioner
for Health &
Family Welfare
Project Director cum
E/O Spl. Secretary to
Govt. [IPP-LX(K)]
I
▼
▼
Director
State Institute of Health
and Family Welfare
Director
Health and Family
Welfare Services
7
▼
Project Administrator
cum E/O Spl. Secretary
to Govt. (KHSDP)
.
ANNEXURE III
Organisational Set up of Health & Family Welfare Department
Directorate Level
Commissioner for Health
Director for Health and Family Welfare Services
Project Director
RCH
■•I
Joint
Project
Director
(RCH)
I
I
I
Addl. Director
CMD
I
Joint
AO
AO
Director (Accounts) (Transport)
IEC
__ L
Joint
Director
(CMD)
I
State
Survei
llance
Unit
77
Joint Director’s (9)
1. H&P
2. M&F
3. TB
4. Leprosy
5. PHI
6. Vaccine
8
CAO
I
AO
CAO
cum
FA
Joint Director
HET
I
Institute
Belgaum
7. Ophthalmology
8. Medical
9. GMS
w 7
Addl. Director
HET
;
▼
Deputy
Director
School
Health
Education
V
Training
Officer
▼
DNO
Technical
Officer
Deputy
Director
(Training)
t
ANNEXURE IV
Divisional Level
1
Director of Health and Family Welfare Services
Divisional Joint Director
Deputy
Director
(Headquarter)
Gazetted
Assistant
Deputy
Director
NMEP Zone
Health Officer
SSA Unit
(LEP)
District Health and
Family Welfare
Department
Medical Officer
Mobile Ophthalmic
CEM Dental Unit
(School Health)
Surgeon
District Surgeon /
Superintendent
District Hospital
ANNEXURE V
Block Level (Below Taluka Level) Medical Officer
Primary Health Centre
Block Health
Educators
(BHE)
Senior Health
Assistant
(Male)
Senior Health
Assistant
(Female)
Lab.
Technician
First Division
Assistant
I
Junior Health
Assistant
(Male)
Junior Health
Assistant
(Female)
9
Computer
Pharmacist
NATIONAL MALARIA ERADICATION PROGRAMME
Dr. M. V. Murugendrappa, Joint Director (M&F)
Malaria has been a major public health problem in developing countries including
India. The malaria institute of India carried out systematic studies in collaboration with the
Health Directorate of erstwhile Bombay presidency (Maharastra & Gujarat) from 1945 to
1952 which formulated the strategy for malaria control in India. The programme envisaged 4
important phases in malaria control viz., (1) preparatory phase, (2) attack phase, (3)
consolidation phase, and (4) maintenance phase. The spectacular success of the programme
led to the launching of National Malaria Eradication Programme in India from 1958. By
1964, total malaria eradication was declared in the country. However, there was a major set
back in 1969 when malaria resurged in the country. An all time high of 6.3 lakh malaria
cases was recorded in Karnataka whereas the total number of cases in the country was 6.4
millions in 1976.
The programme was reviewed in depth and Modified Plan of Operation (MPO) wasintroduced in the country in 1977. The incidence of malaria was brought down to 2 million
cases in India and only to 32, 293 cases in Karnataka by 1984.
There has been an increasing and decreasing trends since then due to constantly
changing ecosystem and change in the epidemiological status, which has resulted due to the
developmental activities. The latest resurgence of malaria has been observed since 1994.
The programme is renamed as “National Anti-Malaria Programme” from 01-04-99.
The objectives of the programme which is in operation is :
i. To prevent deaths due to malaria,
ii. To bring down the malaria morbidity to the lowest level,
iii. To maintain the gains achieved,
iv. To encourage community participation in malaria control.
The main components of the programme are
i. Surveillance and case detection,
ii. Examination and treatment,
iii. Residual insecticide spray operation.
iv. Entomological studies on vector behavior-and resistance status of
vector to
insecticides,
V. Bio-environmental methods to vector control and
vi. Information Education and Communication activities.
Surveillance:
F
Regular fortnightly surveillance'(Activity surveillance) is done by the Health worker
visiting house to house, to screen the fever cases and to administer presumptive treatment
after collecting blood smear. Passive surveillance is-done at the Primary Health Care,
Primary Health Units, Hospitals, Dispensaries, Fever treatment depots, Malaria clinics, etc.’
10
where fever cases visiting these institutions are screened for malaria and treated with
antimalarials.
Laboratory Services :
Laboratory services have been provided at PHC level for
smears.
examination of blood
Radical treatment:
rs,
Residual insecticide spray:
Regular rounds of insecticides spray operations with DDT, Malathion and Synthetic
Pyrethroids in rural areas, reporting an Annual Parasite Index of 2 and above, are taken up.' '
Entomological Studies:
th. Qt
entom°logicaJ teams 316 P^ded - one in each division, which is functioning in
the 8tate for regular entomological studies, in order to study the prevalence of Vector
Species, bionomics and resistance status to the insecticides, etc.
Bio-environmental methods:
Special emphasis has been given for implementation of bio-environmental methods of
malana control; which consist of stocking of Iarvivorus fish in mosquito breedi
XationTf di’ffP° rS 'T’ /H°ng
englneennS methods’ seekW inter-sectoral cooraination or different sectors/departments.
IEC activities:
nrr) f T^e Informatlon Education and Communication activities have been taken - uo in
order to i) create awareness among the community about Malaria, ii) encourage community
participation in prevention and control of malaria and iii) propagate with die theme of
malaria control - every one’s concern” and “ conducting animal^ monTeve^
order to’SS
“
Project Areas :
eStablishmrC‘i"f
aC'iViti'S “
stackshino four anti-malaria unkts at Almatti
Almatti
Bheemarayanagudi, and Narayanapur (Gulbarga district).
“ ■>'»
(Bijapur
Krishna ProjeCt, by
District),
Kembhavi
’
The malaria control activities in the State is implemented as per the Guidelines of the
Directorate of NMEP, (Government of India) Delhi. The nrooramm/ie
a
National Anti-Malaria Programme” with effect from 1 st April 1999 °
rename as
11
The programme is monitored at State level by the State programme officer viz., Joint
Director (Malaria & Filaria). He is assisted by the Deputy Director (Malaria & Filaria),
Senior Entomologist and Scientific Officer at the State level, the Zonal Deputy Directors at
the divisional level, the District Malaria Officers at the District level, and the Medical
Officers of Health at the PHC level.
The incidence of malaria in the State, form 1991 is as follows:
Year
Malaria
cases
P. Falciparum
cases
Radial
Treatment
ABER
SPR
SFR
API
1991
Total B/s
collected &
examined
68,45,523
44,565
10,135
43,430
17.2
0.7
0.2
1.2
1992
69,18,592
81,057
16,826
63,200,
17.1
1.2
0.2
2.1
1993
70,98,519
196,466
49,246
190,644
17.3
2.8
0.7
4.8
1994
71,10,997
266,679
37,789
257,338
17.9
3.8
0.5
6.8
1995
71,11,888
285,830
39,601
279,535
17.4
4.9
0.6
, 7,0
1996
76,81,802
219,198
32,606
216„27
18.5
2.9
0.4
5.4
1997
76,13,013
181,450
46,326
180,976
17.8
2.4
0.6
4.2
1998
(Provisi
onal)
73,50,068
107,910
23,469
102,152
17.7
1.5
0.3.
2.1
”1999
16,99,032
13,842
2,224
13,421
0.8
0.1
17,64,132
22,440
6,189
21,468
1.3
0.4
(March)
1998
(March)
The incidence of Malaria began to increase from 1993 and was highest in 1995 for the
current decade. After concerted efforts by the department, the incidence was brought down
by 2j% during 1996, by 36.5% in 1997, by 40.5% during 1998 and an overall decrease of
62% has been achieved during 1998, as compared to the peak incidence of 1995.
URBAN MALARIA SCHEME
The concerned local bodies, in 8 cities/towns of the State, viz.. Bangalore, Bellary,
Hospet, Belgaum, Raichur, Hassan, Chikmagalur and Tumkur are implementing the scheme.
To control malaria in urban areas, Urban Malaria Scheme under the National Malaria
Eradication Programme was implemented in the State, from 1972. The scheme is
implemented in towns with a population of above 40, 000 and having problem of malaria.
The main activities under the scheme are 1) anti-mosquito measures i.e. antilarval
measures by weekly application of larvicides, 2) source reduction measures to prevent the
breeding of mosquitoes along with adulticidal measures with Pyrethrum space spray in and
around the house where malaria cases are detected.
The detection and treatment activities are also taken-up in urban slum.
12
During 1999, the cities of Bellary and Mangalore continue to be problematic But the
scheme is not in vogue in Mangalore City. However, the Filaria Unit Staff existing under
Mangalore City Corporation implements the control measures.
Further, Bangalore and Bellary cities are identified for implementation of Accelerated
Malaria Control Programme under the World Bank assisted Enhanced Malaria Control.
The epidemiological data under the scheme is as follows:
Year
Malaria cases
1994
B/S collected &
Examined
126938
1995
4238
P. falciparum
cases
248
Radical
treatment
3394
136931
13136
428
12866
1996
166784
16545
782
16407
1997
150267
14450
937
14213
1998
141008
8739
750
8355
1999
24814
549
34
511
;
(Upto March)
NATIONAL FILARIA CONTROL PROGRAMME IN KARNATAKA
The Filaria control activities are implemented in the districts of Gulbarga Biiapur
Bidar, Raichur, Dakshina Kannada and Uttara Kannada. However, the Districts of Bi apur’
Kaichur and Dakshina Kannada are now bifurcated into Bagalkot, Koppal and Udupi
districts respectively and these districts will be reporting the data from 1999 onwards.
Under the Filaria Control Programme, there are 8 Filaria Control Units and 25 Filaria
climes functioning m the above districts, in the endemic towns. A Filaria Survey Cell is
nctiomng at Raichur, which is also conducting filaria survey.
th
maLn activities under 1116 programme are : anti-larval measures carried out
through Filaria Control Units while Filaria Clinics undertake parasitological survey to detect
StrateX^^0'?^3^'1 dlSeasekmanifested cases with DEC tablets (Diethyl Cardamazine
Citrate tablets). The objective of these activities is to delimit the problem of Filaria in State.
Physical progress:
Year
No. ofpersons
Examined
1995
122484
No. persons
+ve for MicroFilaria
964
1996
1354469
1073
4853
5926
1997
0.79
208827
1344
5615
6959
1998
(Provisio
nal)
0.64
132981
1235 '
5711
6946
0.93
1999
(March)
32423
216
1674
1890
0.67
No. ofpersons
with disease
manifestions
3480
No. of
persons
treated
4444
Microfilaria
rate %
13
0.79
NATIONAL AIDS CONTROL PROGRAMME IN KARNATAKA
Dr. P.N. Halagi, Additional Director (AIDS)
Objectives :
•
•
To initiate major effort in the prevention of HIV transmission and to launch
expanded preventive activities.
To slow the spread of HIV so as to reduce the future morbidity, mortality and
impact of AIDS.
Programme Interventions:
1. To attain a satisfactory level of public awareness on HIV transmission and
prevention.
2. To develop health promotion intervention among risk behaviour groups.
3. To screen majority of blood units collected for blood transfusions.
' "
4. To decrease the practice of professional blood donations.
5. To develop skills in clinical management, Health Education and Counselling and
Psycho-social support to HIV Seropositive persons, AIDS patients and their
associates.
6. To initiate strengthening of STD controls.
7. To monitor the development of HIV/AIDS epidemic.
The components of National AIDS Control Programme are as below :
1. Programme Management
i.
Establishment of State AIDS Cell.
ii.
Formation of Empowered Committee.
2. IEC (Information, Education and Communication).
3. Surveillance and Clinical Management.
4. Blood Safety.
i.
Blood Component - Separation facilities.
ii. Modernisation of Blood Banks.
iii. Zonal Blood Testing Centres.
5. STD Control Programme.
6. Training Programme.
There are eight (8) AIDS Surveillance Centres in the State functioning at the
following places:
1. AIDS Surveillance Centre, Dept, of Microbiology, Bangalore Medical College,
Victoria Hospital, Bangalore.
14
2 M “paT"eiUanCe C“,r'- D'?l-or Microbiology. Kasturba Medical CoUege,
3. St^NX'sc'lence’ D'1”' Of N'“ro-V™logy, National Inst. Of Mental
4. AIDS Surveillance
Myiore.
'
5. S “n'esSr
y
Dcpt °f Microbiology, Mysore Medical College
Karnataka Inst. Of Medici'
6 S®„SceSs^:;^Ce C“tre' Dept- of Microbiology, Vljaynagar Inst• Of Medical
Da?mafeUr7"n““ a”1"’ DeP'' °f Microbiology, JIM Medical
College,
-8‘ S”bSargSa""eillan“ C“,r'- D'pt ’f Microbiology,
M. R. Medical College,
And there are 10 zonal Bfood Testing Centres fonctioning i„ the State at ,he fo,Iowing
places.
1.
Bfood 12 ™»dXfoXfoe K d' G'7'H0SPiB,’B*-’
2.
, Hosur
T"
~ ;Bangalore.
___ o_._.
8
Road,
Bank / Zona, Blood Testing
ntre’Kldwai Memorial Inst. Of Oncology
4. Blood Bank / Zonal Blood Testing Centre, Kasturba Medical College Maninal
5. B o°d Bard< ^0Qa’Blood Testing Centre, M. R. Medical College, Gnlba^®3
6.
7.
.«; z z zzz
Bellary.
8.
Vtjayanagar Inst. Of Medical Science,
Bank/Zonal Blood Testing Centre, HSISBoshia Hospital BMgaIore
9- Blood Bank / Zonal Blood Testing Centra c
“^galore.
Bangalore.
Command Hospital,- AIR Force,
>0. Blood Bank /Zona, B!ood Testing Centre, IN Med.ca! Co.lege, Belgannt.
being strengthened°by »™f "up^’y"/0^
consumables and drugs enabiinT L VstiMonTm
SXXX“ora,o'y S"p'’li'!’
BtodT™“PdH'V
D0OTdtors'’»
News Paper ^.ertise® e“
15
"
"“'en“IS'
for
^ertisemej a„d
The existing Blood Banks attached to Government Hospitals and Private Commercial
Blood Banks are linked to the existing Zonal Blood testing Centres for screening of Blood
samples for HIV before Blood transfusion.
HIV Testing Policies
As per guide lines of National AIDS Control Organisation Government of India, the
following four types procedures is followed :
1•
2.
3.
4.
7.
Voluntary Confidential Testing.
Testing for Surveillance purpose.
Testing for Diagnostic purpose.
Mandatory Testing.
Voluntary Confidential Testing:
The Voluntary Confidential Testing is done at Voluntary Blood Testing Centres
(AIDS Surveillance Centres), by giving pre-test Counselling and post-test counselling'to
those individuals who approach voluntarily to know their HIV status.
The individuals will be subjected to one test by simple rapid test or Elisa, if the result
is positive, the sample will be subjected for a second test with a different antigen principles, if
found positive it will be taken as HIV Sero-positive.
2.
Testingfor Surveillance purpose :
The unlinked anonymous testing procedure is followed duly adopting the coding
system. This is done to know the trends of HIV Infection in a particular group over a period
of time. The epidemiological data is used for planning preventive strategies. Samples group
will be from high-risk groups or low risk groups. The Surveillance will be done for a period
of six to eight weeks for a sample size of 250 to 400 by designing a Standard Protocol.
The samples will be subjected to testing by one type of test kits, the positive samples
will be again subjected for a second test with different antigen principle. The positive result
of second test will be considered a HIV Sero-positive. This kind of study will be conducted
twice in a year. The test will be done at voluntary Blood Testing Centres (AIDS Surveillance
3. Testingfor Diagnostic Purpose :
This test will be done at Voluntary Blood Testing Centres (AIDS Surveillance
Centres). The samples of Clinical suspected cases referred by Physicians / Doctors will be
tested for confirmation to diagnose and manage the case. Here three types of tests will be
done using different antigen principles. The first reactive sample will be tested by second test
and the subsequent reactive sample will be tested by a second test and the subsequent reactive
sample will be subjected for third test? If the sample is reactive in the third test will be
confirmed as HIV Sero-positive. The result will be utilized for AIDS case diagnosis and
management.
16
I'
4. Nlandatory Testing:
1
J
Mandatory testing will be done at Blood Bank to ensure Blood transfusion safetv ah
Blood units collected for transfusion will be tested mandatory by one test only either bv
Sde^ “ OT, T1 t SpOt “■ 'f ,he
15 ” 'd“,ity °f b,0°d
“on S «=i
is
B'°°d TeS,i"g C“'rK <AIDS
i. department of microbiology.
Bangalore Medical College, Victoria Hospital,
Bangalore - 2.
2. DEPARTMENT OF NEURO-VIROLOGY
The National Inst, of Mental Health & Neuro-Sciences
Hosur Road, Bangalore.
3. DEPARTMENT OF MICROBIOLOGY,
Kasturba Medical College,
Manipal, Dakshina Kannada District.
4. Mysore Medical College,
Mysore.
5. Karnataka Institute of Medical Sciences
Hubli
6. Vijaynagar Institute of Medical Sciences
Bellary
7. M. R. Medical College
Gulbarga
8. J. J. M. Medical College
Davanagere
17
B1L
£
Centres) are located at the
NATIONAL TUBERCULOSIS CONTROL PROGRAMME IN KARNATAKA
Dr. HG. Narayana Murthy, I/c Joint Director (Tuberculosis)
National Tuberculosis Control Programme in India was started in the year 1962.
Similarly, in Karnataka State also it was implemented from 1962 onwards. In the year 195758 ICMR (Indian Council of Medical Research) conducted national sample survey regarding
the epidemiological status of Tuberculosis in the country. Tumkur District from Karnataka
State was taken under the pilot project. In this study in a developing country like India 2% of
the population do suffer from Pulmonary Tuberculosis. Out which, 0.4% are sputum
positives. Rest of the patients are X-ray suspects. In Karnataka state all the districts have
been implemented under National Tuberculosis Control Programme, in which there is a
qualified and trained Medical Officer and trained key personnel who implement the
programme in the district. In addition to district TB centres 5 (five) more additional district
TB Centres are established. The estimated number of TB patients in India is around 14
million. Out which, 3 to 3.5 million are sputum positives. About 0.5 million pulmonary
tuberculosis patients are dyeing every year. Approximately, thousand patients die from
pulmonary tuberculosis per day. This accounts almost one death per minute. One sputum
positive pulmonary tuberculosis patients can infect 10 to 15 healthy persons per year.
Among all the infectious diseases Tuberculosis is the number one killer. About 40 to 50
percent of the population are infected by Microbacterium tuberculosis, which is the causative
organism for TB. This is the magnitude of pulmonary tuberculosis in India.
In Karnataka about 10 lakhs patients are suffering from pulmonary tuberculosis. Out
of which, 2.5 lakhs are sputum positives. The average population of each district in
Karnataka is to the extent of 2 - 2.5 million. Out of this population the estimated number of
sputum positives is to the extent of 7500. These sputum positive cases are being detected in
peripherla Health Institutions (PHUs, PHCs, Taluk Level Hospitals, District Level Hospital
and Teaching Medical College Hospitals) by sputum examinations. Wherever necessary Xray chest are also undertaken after confirming the diagnosis necessary anti- TB treatment are
being given to the patient as per the guidelines of Government of India for appropriate period.
Follow - up sputum examinations are being undertaken during the course of the
treatment (at the end of the 2nd month, 4/5 month and at the end of the treatment). Short
Course Chemotherapy in the State was started in the year 1985 - 86 in a phased manner. At
present, all the district are implemented under short course chemotherapy for the sputum
positive patients.
Revised National Tuberculosis Control Programme is being started in the State in the
State in Six District in a phased manner in the coming 5 years (Bangalore (Urban), Bellary,
Bijapur, Chitradurga, Raichur and Mandya ). The World Bank assistance is to the extent of
18.32 crores for this project in the coming 5 years. Later onwards this programme will be
extended to the other districts also. DOTs is being introduced in these districts with the help
of Anganawadi workers, Mahila Swasth Samaj workers, under the guidance of our Multi
purpose workers. To monitor the National Tuberculosis Control Programme in the State,
Lady willingdon Demonstration and Training Centre was upgraded to Lady Willingdon State
TB Centre in the year 1982. The State TB Centre monitor the National Tuberculosis Control
Programme in the entire State. Similarly, District TB Centre monitor the activities of
District Tuberculosis programme in their respective districts in the State. There are 178 X18
t*'
ray Centres, 804 microscopic Centres and 842 Referel Centres for
case detection and to treat
1 o patients.
X
by both central and state share to the extent of 50:50.
°
r°gramme 1S be,ng Wlemented
■?
being given to the teachers village leaders so that a .h .
• H
steps. F»r“ce«l™ pZe„“ ioTST’
Marest '»
“ a“ Pa,ie",S
01 Educatlon is
“ a'S0 S0U811,
Private practitioaess and
“s:
c^.
L staXs of taPriwe Medical Sfe5>n tothetTe “ WcL^X^have^f””'’ °J
more .nrportan. role to play in the Revjsed
Tube^dtos^X^e
“» P-’- -ospitai
organisations in aePZ' f
influence on the suffering community Thev are
• r j 1 j h° d 3
amount of
Hospital and are capable^^of co”2„I„K;»s spec.absed and organised as Govenmrem
as efficiently as possible A workable conrH’ f T“bercuIosis Control Programme methods
private hospital organisations would certainly^eTd^etSTesuT
departtment and these
at the source itself, bv detecting infections Th
i • S tS In st0PPlnS the TB infection
tocure.
'
& infectious Tuberculosis cases and treating them totally
rimed at stopping the
Xtng^^^^^
and with the assistance offered by World Bank.
organisations are going to be^usVS fnikM
19
gUldance of Government of India, WHO
t0 Gov™ent
NATIONAL PROGRAMME FOR CONTROL OF BLINDNESS IN KARNATAKA
Dr. V.N. Nookapur, Joint Director (Ophthmology)
L
Introduction :
The National Programme for control of blindness formulated in 1976 as a Centrally
Sponsored Scheme.
IL
Objective:
The programme aims at reduction in the incidence of the blindness from 1.4% to 0.3%
by 2000 A.D. The main cause of blindness is cataract which covers 82%. The population of
Karnataka is 4.8 crores. The incidence rate in Karnataka is 1.2%. The estimated incidence is
above 4.5 lakhs. To tackle this aspect following infrastructure was developed.
1. Onestate Ophthalmic cell has been created to plan, monitor and to evaluate zthe
programme.
2. Minto Ophthalmic Hospital, Bangalore has been upgraded as Regional Institute of
Opthalmology to provide advance eye health care.
3. Five medical colleges have been upgraded to provide higher ophthalmic service.
They are
a) JJM Medical College, Davanagere.
b) J. N. Medical College, Belgaum.
c) K. M. C. Hubli.
d) Medical College Mysore and
e) Medical College, Bellary
4. All district hospital of Karnataka have been developed to provide surgical / clinical
ophthalmic services and in addition Gen. Hospital have been upgraded at Hospet,
Udupi, KGF, Gadag and Holenarasipura.
5. 29 District Mobile Ophthalmic units are established at Davanagere, Chickmagalur
Bijapur, Raichur, Karwar, Tumkur, Hassan, Bidar, Shimoga, Dharwad, Mandya,
Mangalore, Kolar, Mysore, Bellary, Gulbarga, Kodagu, Belgaum, Chitradurga, K. C.
General Hospital, Jayanagar, Bangalore, Bagalkote, Chamajanagar, Koppal and
Gokak, Tiptur, Yadgir, Gadag and Hospet.
6. 416 PHC’s were developed with a creation of one Ophthalmic assistant post.
7. Three eye banks are functioning at Minto Hospital, Bangalore:
Mysore and District hospital, Belgaum to provide grafting services.
K R. Hospital,
8. Danida is supporting NPCB Programme by providing following facilities;
a) Equipment &, vehicles to mobile Ophthalmic units.
20
T
e
b) Equipments to Primary Health Centres.
c) Continuing education training Programme for medical officers of PHC’s and
PMO’s.
d) Recurring expenditure of State Ophthalmic cell.
e) Supporting and monitoring of District Blindness Control Societies.
In all the districts District Blindness Control Societies have been established. The
Deputy
Commissioner
Chairman.
will
be the
Member q will
t be the
tu VT’"”’ The DPM Wil1 be aPPointed by DANIDA who
win oe the Member Secretary. The following are the functions of DECS.
a) ■ Periodically assess the magnitude of the problems of blindness in the district & to
monitor and to report.
b) L°ororganisation in arranging camps, provide free spectacles to the
poor patients who have under gone cataract surgery.
c) Grants to voluntary organisation for free eyecamps.
fid’ DANICA is giving financial assistance directly to th<
tese societies through Government
IV Physical Target & Achievements Under NPCB
Year
1993-94
Target
1,40,000
Achievement
1994-95
1,40,000
”1,45,000
” 1,48,274
”1995-96
1996- 97
1997- 98
1,50,000
’1,68,000
1998- 99
1,84,800
93,359
Percentage
66.71
105.90
” 1,34,665
92.10
1,36,683
95.40
1,60,323
79.00
~ 1,33,532
_______
Up to Jan 99.
Allocation of funds & Expenditure of State Plan Scheme
Year
1993-94
Allocation
30.00
Expenditure
13.44
_ _____ Remarks______
■ Due to non-filling Up of
vacant posts
1994- 95
30.00
21.04
1995- 96
30.00
27.04
1996-97
35.00
. '32.56
1997- 98
69.63
” 85.93
1998- 99
147.00
59.11
21
— do—
Upto Feb.99
Allocation of Funds & Expenditure Towards Central Share
Year
1993-94
State
Allocation
50.00
Actual
Released
70.44
Allocation of
Govt of India
70.44
Expenditure
Remarks
29.58
Due to non-filling up
of vacant posts.
1994-95
80.00
76.96
76.96
63.19
1995-96
100.00
89.39
44.70
74.32
1996-97
110.00
74.44
97.19
97.13
1997-98
110.00
27.00
20.66
11.96
1998-99
42.57
61.20
30.60
16.41
Upto Feb. 99
Under National Programme for Control of Blindness, IOL insertion training is given
in Minto Hospital, Bangalore. Duration of the training is 2 months. Two eye surgeons .are
deput 50 for each batch. At present 27 eye surgeons have undergone IOL training.
Under National Programme for Control of Blindness, Paramedical Ophthalmic
Assistants training has been started in four Government Medical Colleges. They are-Minto
Eye Hospital, Bangalore / K. R. Hospital, Mysore / KIMS, Hubli / VIMS, Bellary. In each
training school 15 students are undergoing training. This training will be completed in the
month of August 99. Rs. 500 /- will be paid as stipend for each student.
22
NATIONAL LEPROSY ERADICATION PROGRAMME IN KARNATAKA
Dr. S.M. Jungay, Joint Director (Leprosy)
Leprosy is a chronic infectious disease caused by Mycobacterium Leprae It affects
."X*"31
niLk-iiiLii uigans.
" alS0 ‘ff“G
Skin’ ™“l“’ ,he
2
Magnitude :
There occurred a steady increase in the number of Leprosy cases in India throuah
lOsTout^of?Xei oSWnS^th L3t7
1951
4-°
eStimated cases
was 57/ 0000 in 1QR
Th
P r
Prevalence of ^ase
inc ease inT
, •
u
resPonsible for this Progressive rises was rapid
leadiX m
P0pulatl0n’ better case detection activities and greater community awareness
leading to voluntary reporting. Till 1981, monotherapy was being used for Ueatment of
Leprosy and WHO standard Multi Drug Therapy (MDT) regimen for cure of Leprosy was
and°'™ilded ” 198L The MDT was started in 1981 in a few districts on experimental basis
(NLEPrin^S^ff
?0I^nThed
Nati°naI Lepr°Sy Eradicadon Programme
(NLEP) in 1983 for providing free MDT services to all the patients. The objective of the
the c?sm?e7aSit0 aCuhieVC eIimmatlon of Leprosy by the end of year 2000 thereby reducing
wls X
“d mto 55.0XTr
11'" ByrateMarCh
1998',he After Modified
“ *=Lenrosv
TX
reduced
lakh and the prevalence
is 5.3/10000.
j
Ri“e (PR> haS increas'd ,0 6'1/,000»
DeZbeH99rPTta1^C),“i''
About 15-20% of the patients are children. The proportion of Multibacillarv cases
tot^ } ^aSeS is42%
31110118 new cases’ 016 same is 300/o- The deformity rat^amone
in theX199MS. “ i,pprOxin,attl>' 6’8%
« 3.7% among newly detected case!
2 6/innnn
>
’
7631 ab°Ut 17000 new cases
detected
prevalence rate is
2.6/10000 populatton as on 31-03-98. 50% of case load is from northern pa^ of Ka^la
The deformity rate among new cases is 0.84%, child rate is 26%.
?
Mode of Transmission :
The mode <of transmission of Leprosy could be by following
way, but it has not been
established with certainity.
1) Droplet Infection
- By sneezing and coughing.
2) Contact Transmission
- Leprosy is transmitted from person to person by close contact
persoT11
->) Other Routes
mfeCtl0US Patient and a healthy bust susceptible
- Lepra Dacillae may also be transmitted via breast milk by
tattoifig needles but there is no evidence
evidence that
that any
any of
of these
these
routes is important in nature.
23
Incubation period:
Leprosy has a long incubation period, of an average of 3-5 years or more. Nearly
95% of the population are immune to Leprosy. Out of 5 susceptible, only 2-3 persons show
the signs of disease.
Cardinal signs ofLeprosy :
1) Hypopigmented or erythematous.
2) Loss of sensation with or without a patch.
3) Thickenced tender nerves.
4) Presence of AFB in skin/nosal smear.
Classification :
Leprosy mamfests in two polar forms. Namely, the Lepromatous Leprosy and
Tuberculoid Leprosy, lying at the two ends of a long spectrum of the disease. Between these
two polar types occur the borderline form depending upon the host response to infection. '
Leprosy is a disease bedevilled by classifications. E.g. the Madrid classification,
Ridley Jopling classification, the Indian classification etc.. The Indian Madrid classification
system are the most widely used.
Indian Classification :
Indeterminate type
Tuberculoid type
Borderline type
Lepramatous type
Pure Neuritic type
In the NLEP Programme and in the field only three types of Leprosy is classified for
the convenience of treatment.
1) Multi Bacillary
- (Infectious) Skin smear positive for M. Leprae.
OR
More than five skin patches.
2) Paucibacillary
- (Non-infectious) skin smear negative for M. Leprae or
five and less than five skin patches.
3) Single Skin Lesion (SSL) - Single Skin patch’without any nerve involvement.
24
5'4
Diagnosis:
k4
Leprosy diagnosis is made mainly by clinical
examination and skin smear
examination.
Clinical Examination
Patch
Sensation Test (Touch, Pain
Temperature)
Nerve Trunk like ulnar, median, radial, lateral
popliteal, posterior tibial are to be examined.
Peripheral nerve like supra and infra orbital
great auricular, radial cutaneous, sural are to
be examined.
Nerve Examination
Eye Examination
Voluntary Muscle Test (VMT)
Trigemina Nerve
Facial Nerve
"Radial
Ulnar Nerve
Median Nerve
-Lateral Popletial Nerve
Posterial Tibial
"
^opt^-almus’ comeal sensation, visionj^T’ the P°Wer °f
-Loss of comeal sensation
>
- Lagophtholmos
- Wristdrop
’
- ------------------ Clawing of little and ring fingers.----------jJ. Clawofmiddle and index finger and thumb
- root drop
- Loss of sensation in the sole of the foot and
claw toes
_
Bacterial Examination:
Three skin
patch has to be
Treatment :
_Dosage (Adult MB)
"
lP2g^(Child MB 10-14 years)----------Monthly Treatment: Day 1
~~
Supervision Dose
------ - -Monthly Treatement: Day 1
-----Rifampicin 600 mg
- ----------- _ Supervision Dose
Rifampicin
450
mg
"
_ Clofazimine 300 mg. ~ ~
_ Clofazimine 150 mg.
—■
f ^Dapsone 100 mg.
I Dapsone 50 mg.
~ ~
Self Administered
“
‘
__Self Administered
Daily Treatment: Days 2-28
Daily Treatment: Days 2-28
-----Clofazimine 50 mg.
Clofazimine
50
mg
every
other
day
Dapsone 100 mg
_Dapsone 50 mg. Daily
Duration of Treatment:
12 blister packs to be taken monthly Duration of Treatment:
H kl*5*61* packs to be taken monthly
Period of 18 months^
within
_Ehma_maximum period of 18 months,
Opsone 23 mg
O™e
25
300 ”S'
Leprosy Reactions:
Leprosy reactions are episodes of sudden increase in the activity of the disease. This
is thought to be due to an alteration in the immunological status of the patient. Reactions are
the major cause of nerve damage and disability in leprosy.
There are two types of reactions:
1.
Reversal reaction or Type 1 reaction: The most important type of reaction is
known as reversal reaction. This may occur in both MB and PB leprosy. The patient
may present with one or more of the following features:
Skin lesions become reddish and swollen
Painful, tender and swollen peripheral nerves
Signs of nerve damage - loss of sensation and muscle weakness fever and malaise
Hands and feet may be swollen
Rarely, new skin lesions may appear
2.
ENL Reaction (Erythemanodosum Leprosum) or Type 2 Reaction: END is
another type of reaction and occurs only in MB cases. The main features are:
tender reddish skin nodules (evanescent)
fever, joint pain and malaise
occasionally painful and swollen nerves
eye involvement may occur
The anti-leprosy treatment should not be discontinued during the reaction.
reaction will be treated with administration of prednisolone for 3 months.
The
The Programme:
The National Leprosy Control Programme was started in 1955 based on treatment
with a single drug Dapsone. With the advent of Multi Drug Therapy against leprosy, the
same was started in a few districts in 1981 on an experimental basis. When National Leprosy
Eradication Programme was launched in 1983, the coverage of districts under MDT was done
in a phased manner and now all the districts have been covered. A District Leprosy Society
has been registered in each district under the chairmanship of District Collector and funds
have been provided to all the District Leprosy Societies for providing free MDT services to
all the Leprosy patients. The programme is being given World Bank assistance for six years
starting from 1993-94.
The strategy to achieve the objective of elimination of leprosy is through effective
interruption of disease transmission that would bring a steady fall in the number of cases
detected every year. Since man is the only practical known reservoir and untreated leprosy
cases are the only practical sources of infection, the best strategy is to lay emphasis on early
detection of leprosy cases and their prompt effective treatment with MDT. The strategies
adopted under the programme are to :
1) Provide domiciliary MDT in endemic districts through vertical trained leprosy
staff to all eligible patients.
2) Provide MDT services through Mobile Leprosy Treatment Units and Primary
Health Care Personnel in moderate to low endemic districts.
3) Intensive case detection and treatment activities.
26
4) Provide health education to patients, their family and community
Provide rehabilitation services to the needy patients wherever possible.
attached to Primary Health Centres (PHCs) or hospital IxX hthe nX
"v
moderate and low endemic areas to provide services to leprosy patients. One I CT rP°cketS °f
*e lerfy patrts in ,he ”w'taK
Modified Leprosy Elimination Campaign (MLEC) :
prevalence“«7o
treated. The n“mber of „e» e " e ZX”'is
200° A D‘ tt,“ is “ bri”S “°™ <he
'ePr0Sy “Y Sh“U
transmission of leprosy infection continues due to hidden"X ofYeom 'i“Tm'a”s s,iU
hidden cases an intense search with mncc ,
niaaen cases of leprosy. To detect all
adopted in the above campaign.
wareness of leprosy disease to the community is
ground of MLEC conducted during April 1998 with the objectives of
OriemX^t
a;Tness regarding
leprosy incommunity
Orientation training of all searchers.
3. Intensive house to house searches to detect leprosy cases.
2
During the first round of MLEC, 46360976 peonle were
enumerated and 3645454
9881 c.Jere eXaminrd
73515 registered as suspected case
of leprosy and out of these,
9881 cases were confirmed for leprosy and put on treatment
•■
objectives
1.
2.
r°Und °f MLEC isis sscheduled
—iCU temauveiy
tentatively inin the
the first
first week of October 99. The
fctiS°f
aWareneSS regarding IeProsy in ^e community through IEC
Centres for the dtagnZ^d^Xel.1 ^TshXXlTe^ciy011111^ RePOrtin§
&Xr^“ SBff
“LEPROSY IS CURABLE”
27
m view of
SCHOOL HEALTH SERVICES
Dr. Jayadeva, Joint Director (HET)
School Health is an important branch of community health. According to modem
concepts, school health service is an economical and powerful means of raising community
health and more important in future generation. The School Health Service is a Personal
Health Service. It has developed during the past 40 years from the narrower concept of
medical examination of children to the present day broader concept of comprehensive care of
the health and well being of children throughout the school years.
Objectives ofSchool Health Services :
1.
2.
3.
4.
5.
The promotion of positive health
Prevention of diseases.
Early diagnosis, treatment and follow-up of defects.
Awakening health consciousness in children.
The provision of healthful environment.
Aspects of School Health Services :
The tasks of school health services are imanifold and vary according to local priorities,
where resources are plentiful, school health may be developed,. Some aspects of school
health services are as follows:
1) Health appraisal of school children and school personnel.
2) Remedial measures and follow-up.
3) Prevention of communicable diseases.
4) Healthful school environment.
5) Nutritional services.
6) First Aid and emergency care.
7) Mental health.
8) Dental Health.
9) Eye health
10) Education of handicapped children
11) Proper maintenance and use of school health services.
School Health Programme in Karnataka :
School health programme was started during 3r4 Five Year Plan implemented bases on
Smt. Renuka Roy School Health Committee Report 1965. Upto 1987-88 School Health
Programme extended to 465 Primary Health Centres and during 1988-89 school health
programme implemented in all Primary Health Centres in the State under M.P.W. Scheme.
School health services unit is one of the unit under the Health Education and Training.
Bureau of Health Education and Training is under the control of Director. Overall inchar^e
of this section is one Joint Director and Additional Director.
The Primary Health Centres are <'
charged with the responsibility of administering
school health service within their jurisdiction,. It requires a whole time medical officer to
cover 5000 to 6000 children a year.
28
supplementation of medicine and other materials is also r
h Ald Klt to the schools and
Stores. Cumulative Health Records for school childrJ .
d °Ut
Government Medical
by D.D.P.I. in concerned districts.
H *S pnnted and suPplied to the school
j
Wth ?“cher SZXJ “ * '^"UP
Panchayat for the Teachers Training Programme.
better, of qualily sehoo.
SanCtlOn ln 1112 budget to Zilla
Sh°"“ b= maintained at the
At District Level
1-
3. ]
4. Stock and
5 SeloT^"^
6 iohoH^Pea Programnle: bfonthiy reports/registers. HCS/™s)'
6. School health survey reports/register (consolidated PHCwise).
II.
8S “d
At PHC/PHU Level:
Map showing all the sub-centres and villages, schools in PHC/PFJT T
2. A master chart in each PHC/PHU.
™C/PHU.
4' StoH^
PrOgramme Performance (Bar diagram).
«cd)b°X’ °“diCi°e
5
d™85-
&pd gXVen*re™Se’-
■
6.
7.
pro8ramme
8' defective
reeis,er
<Teachers’
Medical
“Ldt^X” se“ ZZ f"8f'“8- “'d^ e™tion.
V t-i
III.
At Sub-centre Level:
1.
2.
3 £5““^
health education nSSsto^hools rt?)”1’011’
b°X’ medicine distribution of
6.
St’ tohowup and treatment and referral
service register.
29
8. Immunisation servie to schoolchildren (DT & TT etc.).
9. If any others.
IV.
At School Level:
Students’ health records.
First aid box.
Students’ immunisation registers (DT, TT & others).
List of private practitioner (chart/register).
P.T.A. meeting register.
Betterment Committee meeting register.
Register for health education activities (film show, health talks, exhibition,
competition, health education materials etc.).
8. If any others.
1.
2.
3.
4.
5.
6.
7.
30
)
integrated child DEVELOPMENT SERVICES (ICDS) scheme
^r' Jaluja Sundaram, Deputy Director (Nutrition)
(
nationaXXT^
initiated in 33 projects in the eonn^ on October 2""
one oi the 3- “b”' ™S
SasTnS m
S‘a,e- °,er
P’5'
XXte XXed prXivZ
and as on today the project covers all the taluk/blocks of the entire State
P g
Y
The urban slums are also a priority area of the i---programme and there are 9 urban
Projects and 7 tribal projects at present and as on today there
- are 184 ICDS projects in the
otate. The main objectives of the scheme are to:
•
Improve the nutritional and health status of children in the age group 0-6 years
in the age group 0-6 years.
child f0Undatl0n for Pr°Per Psychological, physical and social development of the
^UCethTCidenCeOfmOrtality’m0rbldit^
deir
CtIV£ co-°rdination of P°hcy and implementation amongst the various
departments to promote child development and
g
nJiTtT the,CaPability of the mother to look after the normal health and nutrition
needs through proper nutrition and health education
AnganStenSS
T^'tf
assistance of the helper.
’
°Ca vo^unteer looks after with the
Department and Women & CMdSve ™ n Department. Both the Health & F W
right from Anganwadi centre to SmXeKn^0^’.nmOTts ?rehCO-Ordi"a,ta8 »• every level
the programme.
der t0 Pr0Vlde the services envisaged under
31
Monitoring Under ICDS :
The programme has got an in-built monitoring system for the health & nutritional
sector and is also being evaluated from time to time by annual surveys, special studies and
other research projects.
While the administrative aspects of the programme are being monitored by the nodal
department viz., Women and Child Development, the activities under Health & Nutrition
sector are being monitored by the Health & F W Department. At present, 184 projects are
being monitored.
The Objective of Monitoring:
The monitoring of Health & Nutrition activities provides scope for
i) Systematic monthly review of the performance of the programme and to solve
issues of co-ordination by both the departments right from field level up to the
State level.
ii) Continued education of all functionaries of both the departments through the'SLT,
BIM & District level meetings and Supportive supervision to the functionaries of
both the departments.
iii) Motivation of all functionaries for better commitment towards the mother and
child care activities.
The System of Monitoring is Through :
i)
Sectoral level meeting including the field functionaries and supervisors
(monthly). SET (sectoral level training) is to be organised by Medical Officers
of the PHU/PHC who is designated as sectoral advisor. Around 20 Anganwadi
workers, one supervisor and concerned ANMs, LHVs participate and continued
education on different topics is also provided by the Medical Officers during
sectoral level meeting apart from review of the progress.
ii) Block level meeting where the District Advisor takes up review of the
programme of the project officers of both departments and the field
supervisors(monthly) at the taluk and all the programme officers of the district
are designated as District Advisors.
hi) District level meeting taken up by Chief District Advisor (D H & F W Officer)
with both the departmental officers at the district level viz., District Advisor
responsible for each project and the Assistant Director of the Women and Child
Development Department (monthly).
iv) Quarterly Divisional level review meeting organsied in 4 Divisions by the
Divisional Joint Director / District Advisors with all the CDA & ADS of the
respective districts where in the participation of the State level functionaries of
both the departments and the consultants from the Medical colleges and HFPTC
principals is also ensured and Central Technical Committee is represented by
Senior consultant for the State.
v) State level meeting convened once a year depending upon the need and the
convenience of CTC-IMCD also.
32
Training of Personnel under Health & F W Department :
The Medical Officers are trained by one day crash programme by the resoective
consultants and the HFPTCs are also involved by including ICDS curriculum in the regular
tarnmgcourses organised by the HFWTC., for the different categories of personnel of Sth
& F W Department viz., MOs, BHEs, LHVs etc.
Monthly Monitoring:
Monthly monitoring reports are received bv the Data Analv-ds rvii
u .1.
is COmPuterised at the Statetevel a^d
senftoCTcIScDltV0?3?
m l
C rC-IMCD
also to Divisional Joint Directors and other State level functionaries
moShZrd to^f"65^ a‘hieved ,Un.der various activities of Health & Nutrition sector every
month and to take suitable remedial measures to improve the programme.
The activities monitored under MMR include:
i) Staff position with training status.
ii) Continued education activities including SET, BIM district meeting and
participants of these meetings.
iii) Visits made to Anganwadi centres by Medical Officers for Health check-up
Health check-up of all the Anganwadi children is conducted by the Medical
Officer of the concerned area once in three months. Wherever specialists'
treatment is required children are referred to different institutions accordingly
motion
tntI°n °f ChiIdren and nUmber °f CaS£S °f seve-/moderate
v) Vital events. Though correct information is not obtainable attempts are made to
improve the quality of reporting by collecting these data.
vi) Performance under immunisation activities.
vu) Adequacies of stock position of items like IFA tablets, ORS medical kits etc.
Survey and Research Activities :
These are being taken up by the consultants
as per the protocol drawn up by CTCIMCD and results published by CTC highlights the
success of the programme in general in
certain areas formation of regional centre u '
under CTC
undertaking research activities
might
provide be® scope
obi/n more dam on
p ogr^TLLX
‘ ” Xi"
1. Vitamin ‘A’ Prophylaxis Programme Against Blindness
In order to prevent severe form of vitamin ‘A’ deficiencv IpaHino- tr. kr u
pre-school children, oral massive dose of vitamin ‘A’ detlCietnC+y leadin8 to bhndness among
the children of 9 months to 3 years One m
>
c?“ate being administered to all
Vitamin ‘A’ concentrate is supplied free of cost by Government oMndiJ
nrn h A preSent’ 1 °’17’000 children under Measles linked vitamin
A and 24,37,000 under
7 X1S Pr°gramme for !-3 years children are expected to be covered
per annum in the
O LdLC.
33
Programme Implementation :
Vitamin ‘A’ is administered to the children by the ANMs of the concerned sub-centre
by house to house visit.
The following guidelines are issued for proper implementation and feedback.
Prophylaxis Programme Against Vitamin 4A’ Deficiency Guidelines.
1. The programme envisages administration of oral massive dose of vitamin 4A’ to all
the children between 9 months to 3 years of age.
2. The first dose of vitamin 4A’ concentrate will be given along with Measles
immunisation and only one ml of the concentrate is to be given during the I dose with
Measles immunisation.
3. The II dose of the concentrate will be given along with the I boster dose of DPT, Polio
and the children will be given two ml of vitamin 4A’ concentrate and subsequently
continued at six monthly intervals upto 3 years of age.
4. One dose of 2 ml of vitamin 4 A’ may be given even to children beyond 3 years up to
five years whenever they are found to be deficient of vitamin 4A’ (prevalence of Bitot
Spot).
5. No vitamin 4‘A’ solution should be kept beyond the expiry date. The field
functionaries should be strictly instructed to utilise the drug before the date of expiry.
6. The administration of the vitamin 4 A’ concentrate both for I dose (1 ml) arid for the
subsequent doses of 2 ml should be given with the spoon given along with the bottle.
No other spoon or lid of the bottle should be used for administration of vitamin 4A’.
7. Only ANMs who are already trained repeatedly under this programme have to
administer the vitamin 4A’ concentrate to the children.
8. Whereever the ANMs post is vacant or during leave of that sub-centre ANM, the
concerned LHV should take the responsibility of administering the vitamin 4A’.
9. The Anganwadi worker should be involved only to enlist the eligible children of the
village so that the coverage of all the eligible children under this programme can be
ensured.
10. The stocks of vitamin 4 A’ bottles should be worked out as per the population covered
by the ANM and LHV should be made responsible to issue and to collect back the
empty bottles after the administration of vitamin 6A’.
11. Vitamin 4 A’ can be stored in a cool dark place in the institutions or sub-centres.
12. The proforma in which the monthly reports are to be sent is enclosed herewith and the
report of coverage for both Measles linked dose and other doses should be reported
alongwith the stock position every month to this Directorate as per the proforma.
13. Proper records are to be maintained by the ANMs for having distributed the vitamin
‘A’ concentrate every month.
14. Field supervision may be tightened and all supervisory staff may be instructed
suitably.
15. The Medical Officers should be instructed to review this programme every month at
the Taluk level and subsequently the programme should also be reviewed at the
District level meetings.
34
i
National Iodine Deficiency Disorders Control Programme
Introduction :
<■
bodv
body
TOhlne ? a micr° nutrien7ssential for the production of thyroid hormones in our
These hormones have profound influence on human development and health ™
heavy rSj
deP“°'1
food XS
““
»bBi”
amount of iodine through
T^aUe.^d3^00’deaf^u^mTsqtint an^sp^tic ^ple^i^1 The3 cnjx of IDD is<dwr'Sdr °f
when .he
for IDD and excess prevalence
3!,™*
1? ’ *1S considered as endemic
deficiency. It is estimated that 167 million peoplXfedia^e afriskTfIDD ^7°
touch 200 million by the turn of the century Presently 2 mfc
tfigure may
goitre, 2.2 million suffer from cretinism anZfi 6 m n • if4
7
estimated to have
The total number of still births and neonaSdeth^i i?.
neurological disorders,
are estimated to be over 90,000.
ttnbutable annually to iodine deficiency
oentrall^'sponsored NaS“ ta ‘cXl'
objectives.
““ °f ““
““
C°ntrol Progra™ne in 1962 with the following
1. Survey of Goitre in suspected areas 1 * *
to^identify and assess its prevalence.
2. Production and supply of iodised salt
to endemic
------- .c areas to prevent and control
goitre.
Resurvey after five years <of continuous supply of iodised salt to assess the impact
of the control programme.
prz-z-,^^?f effective achievement of these
(NGCP Nationa SoTZZ m —
-ended the
■
L°ntr01 Programme to all the states and union territories with 100%
financial assistance.
35
The 1992 Government of India, considering the wide spectrum of iodine deficiency
disorders redesignated the National Goitre Control programme as National Iodine Deficiency
Disorders control programme.
Goitre Control Programme in Karnataka :
Initially the goitre survey conducted by Government of India survey team in 1986
revealed 41.11% of goitre in three taluks (Sringeri, Koppa, Mudigere) of Chikkamagalur
district of Karnataka State.
Government of Karnataka took initiative and launched NIDDCP programme in 198889 as 100% centrally sponsored scheme.
As per the first objective of the NIDDCP, goitre survey was conducted in all the
districts of the State by the trained survey team.
Around 2.37 lakhs individuals were covered and four districts i.e., Chikkamagalur,
Dakshina Kannada, Kodagu and Uttara Kannada were identified as endemic districts." The
results of the surveys are as follows:
Percent Prevalence of Goitre in Karnataka State
SI.
No.
Name of the District
1.
Chikkamagalur
2.
Kodagu________
3.
D.K. (Mangalore)
4.
U.K. (Karwar)
5.
Shimoga_______
Bidar__________
6.
7.
Gulbarga_______
8.
Bijapur
9.
Kolar__________
10. Belgaum_______
11. Tumkur________
12. Hassan________
13. Raichur________
14. Bangalore (R)
15. Bangalore (U)
16. Mysore________
17. Dharwar_____
18. Mandya______
19. Bellary _______
20. Chitradurga
Total
Total No. of
Villages
Total
Population
covered
5
60
17
25
50
12
21
11
4
21
37
35
12
29
8
30
35
5
16
3,196
4,623
15,644
15,091
22,003
8,805
9,582
5,303
2,048
16,243
17,328
21,553
7,765
15,853
5,373
14,475
23,680
2,976
10,054
15,738
2,37,333
25
404
Tatal No. of
Percent
Goitre
prevalence
cases
1,314
41.11%
1,069
23.12%
2,219
14.18%
1,611
10.67%
1,525
6.90%
. 473
5.37%
465
4.85%
244
4.60%
61
2.97%
411
2.53%
388
2.23%
441
2.04%
151
1.94%
284
1.79%
93
1.73%
234
1.62%
374
1.57%
36
1.20%
101
1.00%
156
0.99%
11,650
4.91%
In the second phase the programme was implemented in the identified four endemic
districts, through issue of Gazette notification banning the sale of non-iodised salt under
36
GoveiSMT"’'5' a't‘'”8i"g f°r Pr°ViSiOn °f i°‘li5Cd Sa" “ per ““ di"c,i°"s °f
Utara Kann/f, n a” ”“ficadon
in Cbikkamagalur district subsequently in
1995 cnZ^,’
« f- f"1 “1
8“ d“™8 '"2 “d in ,he e"tire Sttte OwinS
io^dine deikiencyXX
“ ““ m0S,
““ C,’'a'’'S, "“‘,”d °f
Educational Activities:
the
In order to create awareness among the community about the importance of iodised
PrteVen?°n cf IDD' Intensive Health Education Activities have been taken up in ah
n.p bXXVXrf:«e^P'in,i”8 ““ diS,ribU,i0” °f hea"h ed“a,ion
Motivation campaigns were also organised in the endemic districts. Buyers and
sellers meet were also organised to sort out the problem of the whole sellers and other salt
traders.
tnn i13,23
ftmctionaries (male & female) from all the 27 districts were trained on
IDD and also about the methodology of testing of iodised salt with the help of field testing
Quality Control :
Order monitor the
of iodised salt supplied at different level samnles of
salt are being collected under PFA at the PHC, taluk and district level and sent to Public
Health Institute, Bangalore for analysis.
bllC
testing SXXSX m°"i,Ored at ,h<!
°f ““
kV"
All the health functionaries (male & female) have I
been provided with field testing kits
'he S*l, SamP'eS “ '1’e COnSU,”er level whe”™r
housVi
---------- in
to’Sea"'
Samples Testing of Salt Tested with the Help of Field Testing Kit by Health Functionaries
Year
1997-98
Total
T2,5 9,466
1998-99
10,19,702
Above 15 PPM Below 15 PPM
4,50,225
‘ "1,76,248
(34.3%)
(29.9%)
4,09,511I
’ ’ 3,51,369
(40.16%)
I (34,46%)
Continuous Monitoring:
37
OPPM
4,32,983’
(35.8%)
2,58,822
(25.38%)
INFORMATION, EDUCATION AND COMMUNICATION (IEC)
Srnt. H.S. Susheela, Joint Director (IEC)
Information, Education and Communication (IEC) has always been a significant
component of India’s Family Welfare Programme. I E C aims at (a) Informing the people
about the programme, (b) Motivating the people to accept the services, (c) Guiding the people
into action or availing the services.
Objectives ofIE C:
1) To dissiminate correct information to the community about Family Welfare and MCH
programme through inter-personal communication, counseling and other specific
media.
2) To elicit community participation in Family Welfare Programme right from planning,
to the monitoring stage, and to ensure increased utilisation of services available.
3) To expel the misconception, myth if any towards the programme and to get positive
response by the community.
IEC Strategy:
To ensure wider participation of the community in the programme, various
communication efforts at different levels, using different media options and interactive
process are in use. IEC strategy focusses on adovocacy, public education, counselling,
motivation, inter personal communication use of mass media and print materials and also
involvement of community through Mahila Swasthya Sanghas, Zilla Saksharatha Samithi and
involvement of sister departments such as Women and Child Development, Rural
Development and others.
Extensive use is being made of Doordarshan, All India Radio, Directorate of
Advertising and Visual Publicity, Directorate of Field Publicity, Song and Drama Division,
Information and Publicity Department.
Planning ofIE C activities:
IEC activities are 100% centrally sponsored scheme, Government of India allocates
the budget and also gives guidelines for various activities to be carried out at State level and
Zilla Panchayath levels.
The annual State level plan consists of wider use of Mass Media, software production
for mass media, production of print materials like posters, folders, books and booklets,
manuals, flip book, charts etc. which in turn will be used by field functionaries as supportive
audio visual aid in I E C activities.
Need based IEC action plans for Zilla Panchayath level are developed annually by
involving District Health Education. Officers. To make district level IEC activities more
locally relevant, addressing weak pockets and underprivileged groups and to ensure greater
mass involvement, Zilla Saksharatha Samithi will take an active role in the implementation of
IEC activities. As per Government of India guidelines- the present budget allocation is made
exclusively for activities through Mahila Swasthya Sanghas.
38
v
4
Implementation :
nrr
Th* IEC activities 316 camed out in the State through District Health Education
H^thSSi D‘StnCt LeVe1’ DepUty Health Education Officer at Sub-divisional level and Block
Health Educators at PHC level. They are responsible to carry out educational oSXdonal
motivational activities on Family Welfare, Mother and Child Health aiid fther health
programme throughout the year in a phased manner as per the plan of action.
Thrust areas under IEC
1) Adolescent health
2) Age at marriage
3) Mother and Child Health
a) ANC care
b) Safe delivery
c) Promoting institutional delivery
d) Handling obstetric emergency referral services
e) Care of the new bom
f) Breast feeding
g) Immunization
h) Management of Pneumonia, Diarrhea
4) Temporary and Permanent birth control methods
5) RTIandSTI
6) Male participation
Mahila Swasthya Sanghas:
'EC
Swasth^Sa^.? “'“‘'b
C™ed
Mahila Swasthya Sangha are women forum, which acts as link between health
Monitoring and Evaluation:
>
■
ae.ivitiesflowZwcTdisMS
39
OBSTETRICS EMERGENCIES
Dr. Jahnavi V. Kumar, Deputy Director, SIHFW
Introduction :
Most of the obstetric emergencies can be prevented in a PHC set up by early reference
of patients with the high risk factors during antenatal period to major Hospitals where
specialist service is available.
The Nurses, ANMs or Dais, rather than the Medical Officer conduct either most of
normal deliveries. But the PHC Doctor should be competent enough to identify and manage
the emergencies for
1) Saving life
2) Alleviating the pain
3) Prevent development of serious complications
4) Stabilize the patient’s condition pending referral.
Mistakes can end up with loss of life or chronic disability. Certain obstetric producers
are essential for treating major complications of Pregnancy and Childbirth. Pregnancy-is not a
disease but 15% of pregnant women land up with obstetric emergencies, because of lack of
facilities on Personal, Equipment and Drugs in the pHs set up. Many women suffer from
debilitated consequences of fill health as a result of poorly managed pregnancies. Applet
from regular Antenatal visits, the high-risk group needs the safest environment for delivery
and after care screening for high risk pregnancy should be adopted
How do you identifye (high risk pregnancy)?
I.
Age
Parity
Too young
<19 Years of age
Elderly
>35 Years of age
Primi
Multi with than 4 Children
Social Status
Weight
< 40 Kgs.
>80 Kgs.
< 140 Cms.
Height
Illiteracy
Medical History :
1)
2)
3)
4)
5)
Heart Diseases
Renal Disease
RH incompatibility
Bone injury
Psychiatric Problems
40
II. Reproductive History (past history of pregnancy - bho) :
1) IUD still birth
2) H/O MR ofplacentaflCUlt
3) Toxemia’s
4) Baby’s weight
difflCUlt f°rCePS (instrumental ^livery),
-IUGR
Big Baby
5) Habitual Abortion - Cervical Incompetence
- Congenital Malformation of Uterus
. “.
crine factors - Diabetes low progesterone’s
o) Treatment for infertility
7) APH, Placental insufficiency
III.
Present Pregnancy Factors :
1) Prevention of Anemia < 8 Gm % HB WHO enitaria < 11 Gm %
' "
2) No ANC, No tetvac injection
3) Malpresentations, twins , Hydraminiose, Operation on genital tract
During ANC on Examination :
1) Uterine size
2) Edema, BP, CVS problems
3) Orthopedic problems
4) Pelvic inadequancy (CPD)
5) Hydromnios or Oligo Hydromnios
IV.
During Labour:
1) PROM
2) Cord problems
3) Prolonged labor more than 18 Hrs.
4) Un-skilled attendant
5) Meconium stalled liquor,Abnormal Heart beat:- Fetal distress
6) Premature labor
7) Precipitate labor
8) Place of delivery
eomni;??311
theSe’ Sudden 311(3 un’exPected situations demand prompt action
complications of pregnancy can be classified into
I)
The
Complications occurring before 24 weeks of Pregnancy :
1) ABORTIONS
2) RUPTURED ECTOPIC PREGNANCY
3) VISICULAR MOLES
Abortion :
viability.
Termination of pregnancy before 24 weeks, before the fetus attains
41
Types:
1) Spontaneous
2) Induced
3) Habitual
Absorption Hazards : Abortion whether spontaneous or induced, whether in the
hands of skilled or UN - skilled persons, are almost always fraught with hazards, resulting in
material morality ranges from 1 - 3.5/1000000 abortions in developed countries.
Diagnosis : Incomplete, (inevitable): where part of the products are expelled or
separated from the uterus.
History: Of Amennoshoca, vaginal bleeding and pain abdomen
General condition : Depends on the amount of blood lost and the previous state of
her health.
Treatment: Record the pulse, BP, investigations done as for any Antenatal case.
PV:
Os is open
Productfelt at the Os or in the vagina
Ut is soft and enlarged
Bleeding from the Os +
Evacuation of products and check curettage done
Before curettage follow these: A - Anathesia
B - Bladder empty
C - Clean the parts
D - Drape the parts
Inj. Ergometrine (methogine) + Antibiotics + Tetvac
2) Vesicular Moles Molar Pregnancy :
Clinical Symptoms:
1) Bleeding PV following a period of Amennorrhoea some
Vesicles passed along with bleeding.
2) Uterine size is greater than the period of Ammenorrhoea.
3) Foetal parts can not be felt
U/s:_Snow storm appearance
Tt After the investigations, arrange for blood transfusion, evacuation of the moles
by suction is the method of choice. Start the patient on infusion of 500 ml of glucose and 510 units of oxytocin, 30 drops per minute, aspirate the contents by suction canula. One week
after evacuation - repeat D & C.
42
Complications of Curettage:
v1
1) Perforation of Uterus
2) Injury to bladder and bowels
3) Heammorrhage
4) Sepsis
5) Shock
6) Rarely amennorrhoea to tosamma
Si
3) REPTURED ECTOPIC PREGNANCY:
Clinicalfeatures:
1) History of missed periods
2) Severe pain abdomen
3) Vaginal bleeding - dark and continuous
patten.
“SeTsx^o^X’ “d
-srx-:
presentZ,^
*
which d^XZSSXr1”^ BT & CT
IL
d“"'
° t.
Complications occurring after 24 weeks of Pregnancy :
dSlive°“o"“L”!'e"”°,'rage : B1MdinS from ™3,n“m in
111
1) PLACENTAL ABRUPTION: Accidental Haemmorrhage due to
premature
separation of normally situated placenta causing retroplacental bleeding
oVdtXX.
piacen,a si“ed
ABRUPTION PLACENTA : 03 types - Concealed most dangerous
-Mixed
-Revealed
Causes:
Toxemia
Trauma
Short cord
Multiparty
I
Folic acid deficiency - poor Socio Economic Status Following delivery of
43
I
Clinical features :
1)
2)
3)
4)
5)
Acute pain abdomen with slight bleeding PV.
Shock
Uterus tender, tense woody hard on palpation
FHS may be absent fetal parts may be difficult to identify on palpation.
Risk of coagulation failure (DIC)
Management:
Resuscitate the patient with IV drip, 02 inhalation and investigations. Accertain the
amount of bleeding and gestational age and fetal condition. Do ARM with Oxytocin drip to
hasten the delivery.
PLACENTA PRAEVIA:
Pain less bleeding per vaginum before delivery of the fetus. General condition
depends on the anemia, and amount of blood loss.
PA:
1) Size of the uterus portion to the gestational age
2) Uterus soft, relaxed, not tender, FP felt
3) FHS may be present
4) Head is high and floating
PV should not be done in O.P. or labor room. Preferable to terminate at 36
weeks by LSCs in II, III AND IV degrees.
2) ECLAMSIA :
Eclampsia is a convulsive state with hypertension and protinurea in pregnant women.
This can be developing during pregnancy or before, during or after delivery. Eclampsia is a
life threatening condition, which accounts for number of maternal deaths.
DIAGNOSIS
Characterized by generalized or localized headache, visual disturbances, restlessness
epigastria pain, nausea vomiting and oligurea.
Management:
The main aim is to prevent and treat complications
1) Control of fits
2) Control of hypertension
3) Safe and speedy delivery of the fetus to save mother’s life
Provide deep with sleep by 10-20 mg. Diazepam IV and slow I.V. drip with 40 mg.
Diazepam in 5% glucose.
i'
44
f
nr.
jat‘ent in semiProne Position, once the sedation has taken the effect and fits
are controlled, and transport the patient.
S
General Management:
Nursing Care:
1) Keep the air way clear
2) Turning the patient to prevent pressure sources
3) Emptying the bladder and bowels
Let forceps with episiotomy. Continue
sedation and antihypertensives at least for 24 hours after the delivery.
Complication :
1.
2.
3.
4.
Inhalation Pneumonia
Accidental Haemmorrahage
Vasomotor Collapse
Renal and Cardiac failure.
POSTPARTUM HAEMMORRAEGE:
Is defined as bleeding from the genital track during the 3 rd
stage of labor that amounts
to more than 500 ml. Within 24 hours of delivery of the fetus.
Types: - A tonic
-Traumatic
Atomic predisposing Factors :
1) Prolonged, stimulated or precipitate labor
2) Over distended uterus - Multiple Pregnancy
-Hydramnios
3) Sub. Involution — Grand multi
Placenta praevia
Fibroid uterus
4) Retained placenta
5) Uterine rupture
6) Placenta praevia and Abruption
7) Uterine inversion
Traumatic :
Lacerations and Haematoma. '
Instrumental deliveries & Trauma
45
Management:
Catheterize the bladder, start rapid I.V. Ringer lactate, to be replaced with blood, next
priority is to stop bleeding.
Patient under Sedation:
1)
2)
3)
4)
Bimanual uterine massage
I.V. 10-20mits. Of Oxytocin drip
I.V. Metherigine
Prostaglandin I.M.
Which will cause contraction of uterus. For traumatic P.P.H. all tha tears should be
sutured immediately & appropriate antibiotics to be administered. In case of un-controlled
P.P.H. refer for Hysteratomy and procedure. In case of retained Placenta evacuation of
placenta immediately done in case of Inversion, correct any inversion of uterus under G.A.
RETAINED PLACENTA:
This is common III stage complication of delivery when the placenta is not expelled
out even after 30 Mts. After the birth of the baby accompanied by excessive blood loss due to
retained or adherent placenta.
Diagnosis:
Examination may reveal relaxed uterus above the level of umbilicus cord may be
hanging down the vulva or avulsed from its site of attachment to the placenta. Such patient
would have lost lot of blood.’
Management:
Resuscitate the patient with 02, I.V. fluids, catheterize and arrange for blood
transfusion. If placenta is separated and retained, under sedation, express by controlled cord
traction.
Manual removal of placenta:
Technique:
After A B C D, put the patient in lithotomy position, cut short the cord at the vulva,
one hand on the fundus and one hand in the shape of cone insert into the vagina, follow the
cord till the fingers detect the margin of placenta detach the placenta completely by sweeping
movement of the fingers. The placenta is extracted by traction of the cold by the other hand.
Final exploration of the uterine cavity is done again give I.V. methergine + Antibiotics.
Complications:
1)
2)
3)
4)
5)
Age
Perforation
Sepsis
Shock
Re-ureic in next pregnancy
46
Rupture of Uterus:
■f.
Can occur -1) during pregnancy - Spontaneous ( Rudimentary Horn)
- Scripture
2) During Labor
a) Obstructed Labor - C.P.D.
- Malpresemtation
- Hydrocephalus
b) Scar Rupture
c) Injudicious use of pitocin Specially in grand multi
d) Instrumental delivery when cervix not fully dilated
e) During manual removal of placenta
Prophylaxis and recognition of rupture are important.
Diagnosis:
1) Pain and tenderness in the scar
2) Presence of retraction (Bandies) ring
3) Serve suprapubic pain
4) Shock, collapse
5) Fetal parts will be felt superficial
6) Uterine contour will be lost and felt separate
Management:
With
investigations. Resuscitate
the
hysterect
oniythe
or repairVl^toeOcs.
Sc^MdasteriltzatTondone^h
bl°Od
INVERSION OF UTERUS :
Causes: 1) fungal insertion of placenta
2) Atony and fibroid uterus
Precipitating causes:
1) Pulling on the cord when the uterus is relaxed
3) Short'cord" ““ a”d"S
0!“” and “I’reSS the
4) Cord wound several times round the baby’s neck
5) Precipitate delivery in the erect posture
Diagnosis: Usually occurs during labor:
I) Vaginal bleeding
■'
J°Wer abdominal Pain with strong chugging sustain
J) Shock due to Hypovolaenia
47
Management:
Immediate reposition under G.A. and resuscitative measures, when the uterus become
contracted, pack the uterus with sterile gauge + Antibiotics.
CORD PROLAPSE:
During labor anticipate and prolapsed in
1) Multipara
2) Hydraminos
3) Twins
4) Prmaturity
5) C.P.D.
6) Malpresentaions
Management:
If the fetus is alive, till the head down to reduces the pressure on the cord- carry out
immediate C.S. If the fetus is dead, if pelvis and presentations favorable spontaneous delivery
is the method of choice.
Conclusion :
From menarche to menopause bleeding per vaginum plays an important role in a
Woman’s life, like wise, the Obstetric Emergencies are connected mostly with
Haemmorrhage, during pregnancy on labor which leads on to mortality and mobility.
These Obstetric procedures are essential for treating major complication of pregnancy
and childbirth to save the lives. Identify the risk of the patient and refer for caesarian section.
Pregnancy is special, but we make it safe by providing regular antenatal care, by
improving the health of women and by providing quality health services.
48
?
MANAGEMENT OF DRUGS
Dr. Bevanoor, Joint Director (GMS)
In a clinical setting such as PHC/PHU and is dealt in the following four aspects.
1. Indenting and purchasing of Drugs and dressings and chemicals.
2. Abe analysis/ Classification of Drugs.
3. Storage and maintenance including bin cards.
4. Procuring of Drugs from G.M.S and sub stores at district hospitals under
K.H.S.D.P Scheme
We should know some facts in brief:
What is meant by “drugs ”
Any medicine for internal or external use of human beings or animals anfl any
substance intended to be used for or in the diagnosis, treatment, mitigation of pain or
prevention of any disease or disorder in human beings including preparations applied on
human body for the purpose of repelling insects like mosquitoes is a drug.
A drug may also be defined as a combination of vegetable or animal or chemical
origin. Drugs affect living protoplasm. When a drug is administered, it acts on the cells and
certain effects are produced.
However there are certain substances used as drug but the mechanism of action differs
such as.
1- Mechanical effect example: Plasma volume expanders LOMODEX, Haemaccel and on
gut liquid parafin.
2. Physical effect:
a) Causing changes in Osmotic pressure example Osmotic diuretic like urea
and cathartic like magnesium sulphate.
b) By absorption/adsorption example being Kaolin Powder and Carbochol the
activated charcoal, which is used to remove gases and toxins from
intestines.
c) Production of lethal rays:Example: - Radioactive isotopes used in Radio-diagnosis and Radiotherapy for
malignancy.
3) Chemical Effect : Example, Aluminum Hydroxide and Magnesium Carbonate
used to neutralise acidity in Acid-Peptic disorders.
4) Most Important is the effect of drugs, which penetrate the cells and without causing
arm to the cells alter their physiology and give beneficial effect.
Now regarding some facts which you should know :
About drugs for purpose of indenting/procuring, that is the
49
Nomenclature of Drugs:
A drug has three names :
1) PHARMACOLOGICAL NAME which is usually un-wieldy and complex, eg.2-Chloro10-pheno thiazine Hydrochloride.
2) Approved Name:- is the name given by the General Medical Council and it should be
used by the doctors while referring to the drug, eg., Chlorporomazine.
3) Proprietary Name:- It is the name assigned to the drug by the manufacturer eg., Largactil
Second example: Pharmacological Name : 4-hydroxy acetanilide-P-acetanido Phenol.
Approved Name:- Paracetamol .
Proprietory Name:-CROCIN, CALPOL, FEBRIL etc.
It is also very important to categorise the drugs in the following aspects:1)
Vital drugs
;.
2)
Essential drugs.
3)
Desirable drugs
4)
Life Saving Drugs.
A detail list of the above category drugs will be dealt will be dealt later on. Medical
Officers have to see that primary life saving, vital & essential drugs are stocked always.
A Medical Officer has to make effort in knowing the most commonly effecting or
occuring diseases in the area of his PHC/Institution. This he can Judge by studying the utility
of drugs for over last 3 years by perusing OPD register or Medicine Stock Book. This will
help him in indenting drugs.
Inefficiency in management of drug system leads to imbalance in health care.
The skills of the Pharmacist have to be improved so that he will be able to deliver the
service by proper management as to see that the right drugs will bes available at the right
time in the right manner to the right patient.
The responsibility for maintenance of drug inventory is of the Pharmacist alone.
The effective drug management depends on :
1) Inventory maintenance.
2) Basic facilities for storage of drugs.
3) Importance of survey and analysis helps in how much, and when regarding
procurement of drugs, organising the distribution, stock movements to prevent
the wastage of drugs.
4) Establishing the accounting system.
5) Only the drugs of absolute need are listed for procurement.
6) Quality is well specified.
7) General reliability offhe source of procurement is identified.
8) Any adverse reaction to any drug in the Institution should be registered /
recorded and he should inform to the concerned proper higher authority.
The following are the categories of the Hospitals in Karnataka, pertaining to the
Department of Health and Family welfare Services and of Medical Education Department.
50
6'
1)
Major Hospitals
16 nos.
2)
District Hospitals
27 nos
3)
General Hospitals/CHC
242 nos
4)
Taluk Level PHC’s
99 nos
5)
T.B Centres
27 nos
6)
PHC
1601nos
7)
P.H.U
600 nos
8)
Subcentres
8193 nos
9)
NLCC/NLCU
31 nos
10)
SET Centre
677 nos
11)
Dental
150 nos
12)
ED
4 nos
13)
TB Sanitoria
4 nos
Classification ofDrugs:
It can be done in two ways
1) According to the systems the drugs act on.
2) According to their action/effect
-------- -— on particular signs and symptoms of ailment.
I. Classification :
Drugs acting on different systems.
The following are the method of analysis of the drugs
as per the system.
(1) DRUGS ACTING ON THE ALIMENTORY SYSTEM
1) Antacids : - E.g. Aludrox, Digene etc.
2) Gastrointestinal Sedatives Eg. Buscopan, Epidosin, Perinorm etc.
3) Laxatives and Lubricants - Eg. Cremaffin, Dulcolax.
4) Drugs acting on the colon & rectum Eg. Proctosedyl
5) Anti-diarrhoeals - Eg. Dependal, Furoxone, Lomofen ’
6) Enzymes, digestives : - Eg. Digeplex, Neopeptine vitazyme.
/) Hepato- biliary drugs Eg. Jetositol, Mecolin.
(2) DRUGS ACTING ON CARDIOVASCULAR SYSTEM
1) Cardiac disorders : - Eg. Digoxin
2) Coronary Vasodilators: - Eg. Nitroglycerin
3) Peripheral vasodialators - Eg. Arlidin and Complamina
^“ri„C°ag“1"tS
Thromoti“^ Eg. Streplo kinase, Thrombospin,
5) Haemostatics
Eg. Bortopase, Siochrome.
51
) I
07494
(3) DRUGS ACTING ON CENTRAL NERVOUS SYSTEM
1) Analgesics and Anti-pyretics :- Eg. Paraceatamol, Metacin.
2) Sedative and tranquillisers:- Eg. 1 argactil 10mg,25mg.,diazepam 5mg, lOmg.
3) Lanti-Emetics:- Eg. Avomine, Stemetil, Metaclorpride Hcl.
4) Anti-Convulsant — Eg. Phenobarbitone 30mg, 60mg.,Diazepam
5) C.N.LS Stimulants :-Eg.Nikethamide.
6) Metabolic Activators :- Eg. Piracetam 400mg
7) Anti-depressant:- Eg. Amsitriptyline Hcl. lOmg, 25 mg.
8) Hypnotic :- Eg. Cardinal 30mg.,60mg.
(4) MOSCULO-SKELETAL DISORDERS
1) Non-Steriodal anti-inflamatory drugs:-Eg. Ibuprofen,Dichlofenac.
2) Muscle-Relaxants:- Eg. Valethamate Bromide Mg Epidosin
3) Rubeficients :- Eg. Methyl Salicylate.
4) Neuro-muscular drugs :- Eg. Piroxicam 0.5%
(5) HORMONES
1) Gonadal Harmone
Eg. Oestragen derivatives, Progesterone derivatives,
Testosterone derivatives.
2) Oral Contraceptives Eg. OVRAL, Ovulen etc.
j) Cortico-steroids :- Eg. Betamethasone, Dexamethasone.
4) Hypogltycaemics
Eg. Oral and Injectables (a) Blibenclamide 5mg. (b)
Chlorpropamide, (c) Insulin.
5) Thyroid and Anti-Thyroid drugs - Eg. Thyroxine 0. Img and Carbimazole 5 mg.
(6) GENITO- URINARY SYSTEM
1) Diuretics and Anti-Diuretics
Eg. (a) Frusemide 20 mg. (b) Acetazolamide
250mg.
(c) ADH
2) Urinary Anti-infectives and Antispasmodics - Eg.(a) Nalidixic Acis (b)
Pyridium,(c) Norfluoxzcin,
(d) Buscopan.
3) Drugs Acting on the Uterus :- Eg. (a) Oxytocin (b) Methyl ergometrine tartarate.
4) Spermicidal Centraceptives :- Eg. Foam Tablets.
(7) RESPIRATORY SYSTEM
1) Broncho-spasm relaxants Eg. Ephedrine, Theophylline.
2) Expectorants, Cough suppressants.
3) Respiratory stimulants:- Eg. Nikethamide.
(8) EAR, NOSE AND THROAT : Decongestants, Analgesic Drops, Dissolving Ear wax.
(9) EYE
1) Anti-infective preparation.
2) Lanti-inflamatory and Anti-Alergic preparations. Eg. Neosporin-H drops.
52
1
x-
(10) SKIN
i
1) Soothing and Protective:- Eg.Ointments
2) Topical Anti-Fungal drugs :- Eg. Miconozole Nitrate
3) Acne
4) Pigmentation disorder:- Eg. Psoralin.
{
(11) INFECTION AND INFESTATIONS
2) SdphSriva^11 Antibi°ticS both broad sPectrum
spectrum.
3) pn?Tu|berC± dru®s ~ Eg- Streptomycin Sulphate 0.75gm
41 An?fiP
2°n
400mg-’ Ethambutol, Isoniazide 100mg/300mg and Igm.,
4) Anti-fungals .- Eg. Ketocanazol, Griseofulvin,
5) Anti-Amoebics :-eg. Tinidazole, Metrogyl.
6) Anti-Mfalarial: Eg. Chloro quinphos, Amodia auzine Hcl
7) Anthelminthics drugs :- eg. Albendazole, Bephenium.
o) Antiviral
9) Sera,Vaccline:- Eg. ASV, ARV, Anti DIPHTHERIA serum.
(12) NUTRITION
1) Appetite Stimulants.
2) Iron, Mineral & Nutritional additive
3) Vitamins
4) Anabolic drugs.
(13) ALLERGIC DISORDERS
1) Anti-allergic drugs:- Eg. CPM, Astemizole.
(14) ANAESTHETICS AGENTS AND INFUSIONS
” TOopemonl a8enB
0Xid'-Ete-
I-ignoeaine,
D'’‘,'°Se 5% a”<1 10%’ Plasma Expanders:. Eg.
2) LomSex.
(15) DIAGNOSTIC AGENTS : Eg. Uro-Miro 420, Urographin.
(16) METABOLIC AND MISCELLANEOUS
1) Chemotherapuetic drugs
Eg. Endoxam '
Eg- Dis"lta 250
S?
(17) DRESSINGS AND APPLIANCES
II. CLASSIFICATION:
53
Analysis of the Durgs :
The other method of classification of the drugs is as follows depending on drug
action.
1) Anti-pyretics:- Paracetamol tab.,Aspirin.
2) Analgesic:- a) Diclofenac sodium, Ibuprofen (b) ketolac
3) Antacids’
4) Anti-Diarrhoeal
5) Anti-Amoebics
6) Anti-Allergies
7) Anti-Inflammatory
8) Anti-helmenthic
9) Anti-asthmatic
10) Anti-hypertensive
11) Anti-emetics
12) Anti-Diuretic
13) Anti-Spasmodics
14) Anti-biotics
15) Haemostatics
16) Anti-Tubercular drugs
17) Sera, Vaccines
18) Sedatives, Tranquillizer, Hypnotics
19) Vitamins
20) Anaesthetics:- Local Acting and general.
21) Eye/Ear/Nose drops
22) Drugs Acting on the Uterus
23) Infusion Fluids
24) Minerals, Nutritional Additives
25) Anti-diabetics:- Oral and Parenteral
STORE-STOCK MAINTAINING PROCEDURE
The following four registers should be maintained in the store.
1) Day Book : 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 receipt, issue
and balance on hand.
3) Bate of Expiry Register : This should be maintained compulsarily to keep
advance track of the drug due to expire. This register should be monitored by
MOH for every two monsths.
Adverse Reaction Register : MOH, PHU, should record any adverse reaction of
any drug either in OPD of in-patient. This matter of adverse reaction should be
brought to the notice of TMO/DHO.
;
54
Jr
•j
?■
BIN-CARD
the pattern of expend!ti
Details on Bin-Card :
and bata" eoSZ Of
Sh°",d b'
like a mirror, which gives complete^^ti^faXig^*118
MO should afest d.e issue
Bin’card is
Procedurefor Disposal ofNearing date ofExpiry Drugs :
being utilised i/your ins^hirions^should^e
°f eXpiry 311(1 which is not
dam of XL
Budget Allocation :
from GMs"and
—from
inS,Oishio.
-U,i°°SSub-S
bUd8eKre
' a"=
“1,i0"-be
No. I)
XX
Circulation of available drugs in the institutions:
*m°"S ““ 0,het
VIM Essential and DalraUe a„d Llfe:
Saving Drugs is as Follows :
(Please see Annexure No.II)
the follo^fng: C°nCluding 111S suggested to have an emergency drug kit which should contain
1) Injection Adrenaline
4) Injection Diazepam.
5) Injection C.P.M.
6) Injection Dichlofenac.
7) Injection Fortwin
8) I.V. Dextrose 5%/DMS/Linger Lactate.
y) injecation Ranitidine
10) Injection Botropase
55
11) Injection Atropine.
12) I.V.Manitol
13) Injection P.A.M.
14) Injection ASV
15) Injection baralgan
16) Injecation Metachlorpropainide+ I.V. Cannula + I.V.Drip Set + Scap-Vein sei.
AN’^EXURE NO. I
BUDGET ALLOTMENT FOR DRUGS AND CHEMICALS
1.
PHU’s
100%
Rs
30,000-00(GMS)
2
PHU’s
50,000-00
20,000-00
30,000-00
1
G.H or C.H.C’s
3,00,000-00
1,20,000-00
1,80,000-00
4
C.H.C’s & Tq. Level PHC
2,00,000-00
80,000-00
1,20,000-00
5.
Sub-centres each
5,000-00
6
Set-centres each
4,000-00
7.
Dental Package Each
10,000-00
&
NLCC
75,000-00
30,000-00
45,000-00
9.
MLCU
30,000-00
12,000-00
40%
Rs
60%
Rs
18,000-00
___________
ABC ANALYSIS
All the 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 the basis of total cost drugs are to be classified into ABC categories.
TABLE 1. ABC Analysis of the Drugs during 1995-96
Items
D
Annual Consumption
Category
Total number
% of all items
Value in Rs.
% of Total Consumption
A
86
16
5137533.88
70
B
125
23
1467866.86
20
C
331
61
733933.40
10
Total
542
100
7339334.14
100
But However VED Analysis is better than ABC Analysis. V = Vital, E
Desirable.
56
Essential ,
■r,
Here you can see the top ten it
.eras expenditure of a particular hospital.
TABLE 2. The Description of Top ten items.
v
J
Items
”1-3
4-6
7-10
Name of the item
Tab Erythromycin 250 mg Cap ampicillin 250 mg
Tab cotnmoxazole Plain
Tab Baralgan Cap Tetracyclines Tab Nidazest 5 mg
(Ethynyl Oestradiol)
s
Dextorse 5% Cap amolox Tab desferol Cap Raricap
Percentage of Total budgets
10/7
6.8
6.8
Total
24.3
TABLE NO.3. VED Analysis
Category of Drugs
No. of Drugs
% of Total Drugs
V: Vital
U6
21
E: Essential
172
32
D: Desirable
254
------------ - ------ ---47~
----_____________
Explain About Lead Time :- Internal & External.
57
1
EPIDEMIOLOGY OF DISEASES AND EPIDEMIC ACT 1897
Dr. M.K Sudarshan, MD[BHU]
Professor & Hod. of Community Medicine
KIMS, Bangalore-4 (0) 6677560 (r) 648364 (r) 648364
EPIDEMIOLOGY OF DISEASES &EPIDEMIC DISEASES ACT, 1897
RELATED TASKS OF MO, PHC \ PHU
DISEASE SURVEYS, OUTBREAK
INVESTIGATIONS &REOIRTUBG
EX. FEVERS, FOOD POISONING,
GE, LAMENESS (POLIO),ETC.
EPIDEMIOLOGY OF DISEASES
AGENT—HOST —^-ENVIRONMENT
AGENT
•
•
•
•
•
•
MICROBILOLOGY
SOURCE &RESERVOIR VIZ. ANIMAL OR HUMAN
ROUTES OF TRANSMISSION
AIR,WATER, FOOD, CONTRACT, ETC
INCUATION PERIOD &PERIOD OF COMMUNICABILITY
IMMUNITY
HOST
• AGE
• SEX
• SESTATUS
MATITAL STAGS
NUTRITIONAL STATUS
OCCUPATION
58
EPIDEMIC DISEASES ACT, 1997
• FOR CONTROL OF EPIDEMICS & OUTBREAKS
EX.GE, CHOLERA, FOOD POISONING
‘ TO
(THR0UGH DH0'IS EM POWERED
.
MA EPIDEMIC AFFECTED PROVISIONS
•
JEKUVldlONS
SR. HA (MALE) & H.I (URBAN)EMPOWERED TO
’ f a?f^ °F EATING establishment HOTELS, WAYSIDE
BAN SALE OF CUTOPEN FRUITS, SWEETS ETC
IF REQUIRED TO TAKE POLICE HELP FORENFORCMENT
FESTIVALS °NGREGATI0N 0F PE0PLE EX. NO FAIRSj
• DENOTIFICATION OF EPIDEMIC FREE STATUS &
RESTORATION OF NORMALIY V+Z. NO CASES FOR TWTSF
mown max. INCLEATION period EX 10 DA™OR
SUMMARY
• DESCRIBE EPIDEMIOLOGY OF A DISESE
• EPIDEMIOLOGICAL METHODS
• EPIDEMIC ACT
ENVIORONMENT
• AIR
• WATER
• FOOD
• SOIL
• HEAT
• NOISE
• RADIATION
• LIGHT
RELATED FACTORS: TIME &‘PLACE
• SORT TERM FLUCTUATION
• LONG TERM TREND
59
TIME
URBAN Vs RURAL Vs SLUM
Ex. SPOT MAPS
DISTRICT Vs STATE/NATIONS
PLACE
EPIMEDIOLOGICAL
OBSERVATIONAL
EXPERIMENTAL
1 .DESCRIPTIVE
1. CLINICAL TRIALS
EX.VACCINES, DRUGS,
PROCEDURES
2. FIELD TRIALS
3. COMMUNITY TRIALS
2.ANALYTICAL
• ECOLOGICAL SURVEYS EX.
IRRIGATION MALARIA
• CROSS SECTRIONAL SURVEYS
EX. DIARH. DIS. SURVEYS
• CASE CONTROL STUDIES EX.
LUNGCANCER VS. SMOKING
• COHORT STUDIES EX. EMOPAL
GAS VICTIMS
60
reproductive and child health services (RCH)
Dr. G. V. Nagaraj, Project Director (RCH)
The Past:
annrnarh°r
30 years Family welfare programme was known for its rimd target based
formnl
W4 Cai? Intemational Conference on Population and ^vempm
Development (ICPD)
emulated a growing International consensus that improving reproductive health
planning is essential human welfare and development.
Proauative-------health1 and family
reproductive health services.
Incentive”2^0^
OrmanCe 8°als
to be replaced by a
and measures focussed on a range of
rep°rt'1995 concludes that, the current contraceptive “Target and
FWPwhich r^t-rr3
planning emphasis to family welfare pro™e
(
) hich is antithetical to the reproductive and child health fRCPn
approach advocated in the GOT toph
♦
110
client centered
Famly Welfare Programme to Reproductive Child Health - The Pteadigm Shift
reproductive healthas a concept and^ome th^T 3 Cle/irer artlculation and definition of
problems should be addressed.
1 mS °n the WayS m which reProductive health
Indian F^nily Welfi^
Bank repOrt °n the
Indian Family Welfare Programme
eexpeditiously
—J*''
to a Reproductive and ChiM Health app oacWRC^Th t0
^-oriented
which ’would be to
—
-3 meet individual client health
high quality services.
principle
of
fertilityThe
” safely
Ze7goal
yX7^^^^
is
^uCe united
serviced as well as to the demographic objective's.0 theJndlVlduals for HlSh ^ality health
61
The report recommends that the targets be replaced by a broad set of performance
goals and greater emphasis on “male 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”
-World Bank - 1995
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 aim to reduce the burden of unplanned and
unwanted child bearing and related morbidity and mortality.
What is reproductive Health?
The 1994 International Conference on Population and Development at Cairo (ICDP)
has indicated a consensus definition as a “State of complete physical, mental and social well
being and not merely the absence of disease or infirmity in all matters relating to reprocuctive
system and its function and processes”
Reproductive health approach means that
•
•
•
•
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-1998)
The reproductive health approach believes that it is linked to the subject of
reproductive rights and freedom and to women status and empowerment. Thus it extends
beyond the narrow confines of family planning to encompass all aspects of human sexuality
and reproductive health needs during the various stages of life cycle.
Reproductive health programme is concerned with a set of
• Specific Health Problems
• Identifiable cluster of client groups
• Distinctive goals and strategies
62
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.
achieving targets to one that ai
New Signals :
■■ s
Shifting to reproductive health approach implies changing the implementation signals.
*°al
’
•
•
demographic
Broademng the service package is necessary
Improving service quality becomes the top priority.
The new signals for a quiet revolution in
the way the programme is planned and
managed are:
Primary goal
Performance measures
Management approach
Attitude to client
Accountability
While still <encouraging smaller families help Client meet their
own health and F.P. needs.
Quality of care, client
client satisfaction, coverage measures.
Decentralised, client-needs driven, ;ender sensitive
Listen, assess needs, inform.
To the client and community plus health and F.W. Staffs
Reproductive Morbidity and Mortality:
d'v'1<>Pi"8 countIy »f »omen 15-44 years of
“V
age if
'’"ff
afd ReX“ve“
(RTFS).
(K11
’
HIV and ReProductive tract infections
women is m outcome of
1-Poverty
2. Powerlessness
3. Low social status
4. Malnutrition
'S.Infection
6.
High fertility
/. Lack of access to health care
Wrt?8 ^fiaternal mortality ratio, usually estimated at 400-500 per 1 00 000 r
birth is fifty times higher than that in the developed contries
’ °0
63
•
Chronic and debilitating conditions such as vaginal fistulas and uterine prolapse
cause terrible suffering.
Child Survival and Safe Motherhood Programme to Reproductive and Child Health
Services :
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.
“i
The main objectives of CSSM Programme are
• Improvement in mother and child health
• Lowering the infant deaths (0 to 1 year) child mortality (1 to 4 years) and
maternal deaths.
The package of services under this programme are :
Children :
1.
2.
3.
4.
5.
Essential news bom care
Immunization (BCG,DPT, Polio and Measles)
Appropriate management of diarrhoea cases
Appropriate management of ARI
Vitamin ‘A’ prophylaxis
Mothers :
1.
2.
3.
4.
5.
6.
7.
Ante-natal care and identification of maternal complications.
Immunization (against Tetanus)
Deliveries by trained personnel
Prevention and treatment of anaemia
Promotion of institutional deliveries
IManagement
'
of Emergency Obstetric Care (EmOC)
Birth spacing
The RCH Package :
During J 995-96, Mandya was identified as Target Free District and the performance
was measured by certain quality indicators. Based on fthe experience, from April 1996 all the
districts in Karnataka have adopted “Target Free ^Approach” and from Sept. 1997 onwards> as
64
eCoXXTF~'lfXX^
Reproductive and Child Health Serves which is equiv°a^mtolmP mented 35 “ lntegrated
•
•
Family Planning, to focus on fertility regulation and
Child Survival and Safe Motherhood Programme and
‘ Ld“ta of AroS.“Ve ™ i"feC,i°nS
Infections
Through :
1. Client Oriented/Mother-Friendly
user - specific, Family Welfare Services
2. High quality services.
The specific programmes under Reproductive and Child Health services are
■ Prevention and management of unwanted pregnacies
Maternal care
a) Ante-natal services
b) Natal services
c) Post-natal services
3. Child Survival
4. Treatment of Reproductive Tract Infections
(RTI) and Sexually transmitted
Infections (STI)
fci™a,i0" 8"ide,ineS Of
hMlth Mentions «, various levels are detailed in
65
Essential Reproductive and Child Health Services at different levels of the Health
Services System :
Health
Intervention
Community Level
Subcenter Level
1.Prevention
and
management of
unwanted
pregnancy
1. Sexuality and
gender information
education and
counseling
2.Community
mobilization and
education for
adolescents newly
married youth men
and women
3. community
based
contraceptive
distribution
(through
panchayats,
village Health
Guides, Mahila
Swathysa
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
to women jj who
are strating pills
for the first
time).
6. Free supplies to
health services
To be piloted
panchayats to
distribute only
condoms.
No.las in
community level
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/
referral for side
effects methos
related problems,
change of method
where indicated.
6. Add other
methods to expand
choice.
7. Providing
treatment j for
minor aliments and
referral for
problems.
8.Social marking of
pills and condoms
through HW (M&F
) may be explored
by permitting her to
retain the money.
66
Primary Health
Centre Level
Nos. 1-6 and
7. Performing
tubal ligation by
mililapon fixed
dates,
8. Performing
vasevtomy.
9. Providing first
trimester
medical
termination
pregnancy upto
8 weeks
(includes MR)
10. Facilities for
Copper T
insertion to post
natal cases
11. treatment
facilities for all
types of
referrals.
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.
Essential Reproductive and Child
Health Services at Different levels of the
Health
Services system :
Health
Intervention
2. Maternity
care Prenatal
Services
Community Level
Subcenter Level
Primary Health
Centre Level
1. Party registration
No. 1-4 and
Nos. 1-10 and
of all pregnant
5.
Three
anenatal
Women
11. Treatment
2. Awareness raising contacts with
women either at the
ofT.B
for importance of
sub-centre or at the 12. Testing of
appropriate care
outreadch village
syphilis for
during pregnancy
sites
during
high
risk
&identification of
immunisation
group and
danger signs
/MCH sessions.
treatment
3. To mobilise
6. Early detection
where
community support
of high risk
necessary
for transport, referral
factors
including
and blood donation
?&matemal
for RTFs
4. Counseling
complications
education for breast
and prompt
feeding nutrition,
referral
* training of
family planning,
7. Referral of
laboratory
rest, exercise &
high risk
technicians,
personal hygiene
women for
etc.
equipment and
institutional
reagents
5. Early detection
delivery
required
and referral of
8. Treatment of
high risk
malaria
pregnancies
(facilities
6. Observing five
including durgs
cleans or
to
be made
through Social
available at
marketing of
subcentress
disposable
9. Treatment for
delivery kits,
TB and folloup.
Delivery
10.
Preventive
planning as to
measure
where? When
against all
and from
communicable
whom?
disease
* The need for IEC
support and first
Referral facilities
67
First referral
Unit/District
Hospital Level
Nos.1-12 and
13. Diagnosis
and
treatment of
RTIs/STLs.
14. Weakly
Clincnics for
High risk
pergnancies.
Health
Intervention
Delivery
Services
Postpartum
services
Community Level
Subcenter Level
1.Early Recognition Nos. 1-4 and
of pregnancy and its
danger signals
5. Supervising
(rupture of
home
deliverys
membranes of more
6.
Prophylaxis
and
than 12 hours
duration prolapse of treatment for
infection
the cord
(exceptsepsis)
hemorrhage)
7. Routine
2. Conducting clean
prophylaxis
for
deliveries with
gonococci
eye
delivery kits by
infection.
trained personnel.
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_______
1. Breast Nos. 1-6 and
feeding
support.
7. Referral for
2. Family
complication
Planning
s
counseling
8. Giving inj.
Nutrition
Ergometrine
counseling
after
delivery
4. Resuscitation
of placenta
for asphyxia
of the
newborn
5. Management
of neonatal
hypothermia
6. Early
recognition of
post partum
sepsis &
referral
68
Primary Health
Centre Level
Nos. 1-7 and
8.Modified
partograph
9. Delivery
services
10. Repair of
episiotomy and
perennial tears.
First referral
Unit/District
Hospital Level
Nos. 1-9 and
10. Treatment of
severe sepsis
11. Delivery of
referred cases
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.
Nos. 1-8 and
Nos. 1-10 and
9. Referral to 11. Managemen
FRUs for
t of referred
complicati
cases.
ons after
starting an PHCs and FRUs
LV. line
would require
and giving equipment and
initial
training for
does of
manage-ment of
antibiotics asphyxiated new
and
boms and
oxytocin
hypothermia.
when
These include a
indicated.
resuscitation bag
10. Managem
and mask and
ent of
radiant warrens.
asphyxiate
d new
bom
(Equipme
nt to be
provided)s I
Health
Intervention
5
Community Level
Subcenter Level
Child survival
I I. Health
education for
breast feeding
nutrition
immunization,
utilization of
services, etc.
2. Detection and
referral of high
risk cases such
as low birth
weight,
premature
babies, babies
with asphyxis,
infections,
severe
dehydration
acute respiratory
infections
(AIR)etc.
3. Help during
immunization
by ANM.
4. Help during
Vitamin ‘A’
supplementation
ANM
5. Detection of
pneumonia and
seeking, early
medical care by
community and
treatment by
ANM.
6. Treatment of
diarrhoea cases
and ARI cases
Nos 1-6 and
Treatment of
dehydration
and pneumonia
and referral of
severe cases.
8. First aid for
injuries etc.
9. Closing
watching on
the
development of
child and
creating
awareness of i
cheap and
|
nutritious food.
7.
69
Primary Health
Centre Level
First referral
Unit/District
Hospital Level
Nos. 1 -9 and
Nos. 1-10 and
10. Management 11.Handling of all
paediatric cases
of referred
including
cases.
encephalo-pathy.
^.Identification
of cetain FRU’s to
provide specialist
services and
training.
Health
Intervention
Community Level
Subcenter Level
Management
ofRTIs/Stis
1. IEC couseling
for awareness
and prevention
2. 2. Condom
distribution
3. Creating
awareness
about usage of
sanitary pads
by women of
reproductive
period
4. Creating
awareness of
about RTIs and
Personal
hygiene
No.l and 4
5. Identification
and referral
for vaginal
discharge,
lower
abdominal
pain genital
ulcers in
women, and
urethra
discharge,
gentital
ulcers,
swelling in
scrotum or
groin in men
6. Duagnosis of
RTI/s and
STIs by
Syndrome
approach.
7. Referral of
Cases not
responding to
useval
treatment.
8. Partner
notification/re
fferral.
Primary Health
Centre Level
Nos 1-8 and
9. Treatment
of Rtis/Stis
10. Syphilis
testing in
antenatal
women
First referral
Unit/District
Hospital Level
Nos. 1-9 and
10 Laboratory
diagnosis and
treatment of
RTIs/STIs
11. Syndromic
approach to
detect and
treat STD in
Antenatal
postnatal 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
c Id 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 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 you4o understand how the reproductive and
child health services are to be provided at the community level. The different services
provided under RCH programme; are:
70
1 • For the mothers:
~
"
—
• TT Immunization
• Prevention and treatment of anemia
• 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 Childrens
• Essential newborn care
• Exclusive breast feeding and weaning
• Immunization
• Appropriate management of diarrhoea
• Appropriate management of ARI
• Vitamin A prophylaxis * Treatment of Anaemia
Ill 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:
■ simp'erard b ,h,!
• 5^'“ “d“8 by 2000-2M2A“'io"»l Srenof™dLl)I'°8
--
Nmth F'Ve
order
According to this
• The funds will flow Government of India through ‘State Finance Deoartment’
(BeX?^ Wil1 bC
- a national compel ^^ect-
•
?hetSFCreated
CSSM Programme Wil be continued under RCH budget
> _ The
»>=i-cyssof
rch p0^:.™11 mon,tor- •-*
following posts have been redesignated;
71
Additional Director (FW&MCH)
: Project Director (RCH)
Joint Director (FW)
: Joint Project Director (RCH)
District MCH Officer
: District RCH Officer
•
•
Procurement will be done through Karnataka Health Systems Development
Project.
Minor Civil Works to subcentres, primary Health Centres, Community Health
Centres will be done through IPP-IX.
II. Funding:
A sum of Rs. 190.10will
crores
1
‘ to 1.Karnataka______
be available
State during the Ninth Plan
as cash and kind assistance. This includes cash
assistance
of
Rs.
------------------------- 15.05 crores exclusively to
Bellary Sub-Project.
III. 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
is ric s a ready have such facilities and the more sophisticated facilities are proposed for the
Al]3 th6 y advance^ dlstncts which have acquired capability to make use of them effectively
All the districts have been categorised into: Category ‘A’-3 districts, Category ‘B’-ll
districts, Category ‘C’-6 districts.
B Y
2n the basis of cryde birth rate and female litercy 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§
72
J
RCH Project - Phasing of Districts :
Year 1
(9)
CAT ‘A’ (2)
(Al) Dakshina
Kannada
CAT ‘B’ (4)
(B2)
Kannada
CAT ‘C’ (3)
Year 2
(8)
CAT ‘A’ (1)
CAT ‘B’ (4)
CAT ‘C’ (3)
Year 3
(3)
CAT ‘A’ (0)
(A3) Mandya
Uttara (B5)
Chikkamagalur
(Bll)
Dharwad
(BIO) Belgaum
(Cl) Bijapur
(A2) Kodagu
(C3 Bidar)
(BI) Hassan
(B7) Mysore
(B3) Banagalore
(R)
(B4) Tumkur
(C2) Bellary
(Sub-Project)
(B6) Shimoga
(C5) Raichur
(C6) Banglore
(B8) Kolar
(B9)
,
Chitradurga
(C4) Gulbarga
CAT‘B (3)
CAT ‘C' (Q)
j
IV Programme Inputs :
1) National Component:
Annual action plan for 1998-99 has been prepared
MCK
by District level will be avSlabl^0^
e-ent
Bud=et for minor repairs both by State Level and also
firS yf^
‘C’ &
■ emergency
other emergency surgical procedures are being conducted
b?S
districts to the
matemal deaths’
caesarean section and
e) Agential Obstetric Care Dniog •
These drugs will be supplied in the form of kits
ot Govt, of India during the first year.
^^^r'^K“^S3,’^"edbberequipped
68 during
rder CSSM
the first year. Two
districts in’A’ category, 4 districts in ‘R’ L
supplied with ‘E’ to ‘P’ kits.
&
73
an^J ^lstricts in 4C’ category will be
g) 24 hours 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 Staff Nurse will be given who attends night deliveries
between 7.00 pm and 8.00
' 1 am.
h) Essential New Bom Care Equipments : Essential New Bom 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 Bom 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.
. , /) ffC Activities : A sum of Rs. 15.00 lakhs is available for taking up innovative IEC
activities focusing on behavioural changes in addition to enhancing awareness regarding
interventions under RCH programme.
j) Vehicle : Field staff particularly Junior ILJL
“ will
..111 be supplied two
Health _„_L
Assistant (F)
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).
k) Minor Civil Works : An amount of Rs. 190.00 lakhs has been made available to
take up minor civil works paticularly in the institutions such as Subcentres, PHCs, FRUs and
also training centres.
l) 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.
m) Seining under RCH : The State Institute of Health & F W will be dovetailing the
H 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
ANM?^6 aVailable at 311 the districts for undertaking six days RCH training programme for
n) 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.
2) Sub Project: Bellary
Annual Action Plan for 1998-99 has been prepared.
Govt oflndia
crores exclusively for Sub Project Bellary has been approved by
74
Civil Works
5 Sub centres, 5 PHCs & 5 Maternity Hospitals
Equipments
■’
CentreS’ 10 PHCS’ 50 PHUs’ 4 Maternity Hospitals
Furniture
. 76 Sub centres, 10 PHCs, 11 PHUs
P
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
75
PERFORMANCE INDICATORS IN RCH PROGRAMME
Objective
Indicators
1997 Base
Line
1998
1999
2000
2001
2002
Data Source
20
0
50
100
60
100
75
100
25
100
50
100
Records (D & E Cell)
Facility Survey / Records
3. Institutional Development Placement
of Staff)
0
10
25
50
75
100
Facility Survey
1. Safe Deliveries
43
50
52
54
58
60
Services Statistics
2. Couple Protection Rate
58
59
60
62
63
65
Survey / Records
3. Infant Mortality Rate (Per 1000 Lbs)
52
50
45
42
40
38
SRS
4. Maternal Mortality Rate
(Per 1000 Lbs)
4.5
4
3.5
30
2.5
2.0
Service Statistics
5. Staff Trained
2
10
30
60
75
100
Records
6. Reached with RTI, HIV / AIDS
Message
20
30
60
75
80
85
Client Survey
7. Unmet Need
18
16
14
12
10
8
House Hold Survey
Crude Birth Rate
22
21.5
21
18
15
12
SRS
I. Improved
1. District Plans CNA Approach
Management
2. SC, PHCs, FRUs, Equipped with
II. Improved
Quality,
Coverage and
Effectiveness
III. Enhanced
Population
Stabilisation
76
i
MEDICO LEGAL PROCEDURES
re
•
Thiwncmikkarasu,
Prof, ofForensic Medicine, BMC, Bangalore
Examination of Injured Person :
Examination of injured person should be conducted in good light.
the injured person should bTobte^ed^If th^inhXjn Wntten’ free 211(1 voluntary consent of
parents or the guardian should b^^obtained
P
°W 13 12
C011sen£ of
ta=
of the case and the
identification of th^erson in&e cTt^t of^aw^10*1 mM1
kS h"
and the address of the injured.
g W h Other
iiyured for the Purpose of
Hke the name, age
n3ture of“Jury’ exact location, exact
measurement in Cm giving kn^breadth^?d°
rmiC
poise,
Any investigation
“J™68 f"u”d
injured. MenttonXSSraXchX
•«
tb' body of the
and any injures which are dangerous in nature offiraT* S
COntUS10ns 311(1 abrasions,
nature. Mention the age of the^njuries found on th
°f t
°r teeth 33 gnevous m
signs of vital reaction and also tte nroS I
“ the baSIS °f fresh bleedmg and
injuries.
’
S°
pr°bable nature of weapon that could have caused the
Issue the wound certificate, whenever
wi out delay, with due acknowledgement of the the investigating officer requires the same
receipt.
MEDICO LEGAL AUTOPSIS
complete autTp^S
S^Medical Offi
inVaIid’ If "
proof of great Medico legal importance mav he d
°5 i"’ evidence whlch later may be
justice may be impede. It is therefore essential
33 3 resuIt’tile c°urse of
complete one. The responsibility of caryin- out a cJ
CaSeS’
3Ut0pSy Sh°uld be a
officer.
P
y
3171118 Out a complete autopsy rest solely on the medical
77
Rules for Medico-Legal Autopsies :
(1) Medico-legal autopsy should be undertaken only when there is an official order
authorising the autopsy from the police or a legistrate.
(2) The medical officer should first read the inquest report carefully and findout the
apparent cause of death from the brief history of the case and circumstances of the
death. If the same is not furnished in the inquest report, the... investigating officer
should be requested to furnish the same.
(3) The post mortem examination should be conducted in day light and not in artificial
light as for as possible, because colour changes, such as Jaundice, colours of the
contusions and post mortem stains etc., cannot be appreciated in artificial liaht. No
unauthorised person should be permitted to be present during autopsy.
(4) The post mortem should as through the complete.
(3) Identification of the body is very important, must be identified by the police constable
number must be recorded. If the body is undefined, the marks of identification on the
body and the clothings briefly described.
(6) The external examination should be done very carefully from top of the head to the
toes noting down all the injuries, with exact measurements and its size, shape and
situations cyamosis 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 discrepancies noted on the body, the same should be mentioned”i
— in the post
mortem report.
, f
A brief general description of the body as to the sex, age, colour of skin hair
ormi les injection marks, tattoo marks to be noted in the post mortem report neck and
head specially should be carefully examined for signs of violence.
nf ■
Not^.down the changes that occurred due to lapse of time after death such as extend
°O be Xd do^ mOrMm S,ain“g “,he dependen,md sisns of to-PosMo'e if any
on the bodv tnT "i
?jUr!etaS t0 •the natUre’ size> shaPe’ edSes
y desenbe in detail, if possible with diagramatic sketches.
^e wound, situation
thf 31maj°r Caviti6S SUCh 33 skuI1’thorax’
abdomen by classical incision and
. amine individual organs in detail for the presence of disease, injury, blood clots, pus etc.,
examinn!;
1S 0336 Of suspected Poisoning or no cause of death is found
on autopsy
examination preserve viscera for chemical analysis and tissues for
Histopatthological
examination whenever necessary.
rd
issue
78
Conducting thepost
•>
ms writing the Autopy Rep0rt.
criminal trials
care and
:S and is especially vital
court of law after a
section of the
—igs.
apparent
= of
s!m of ae
'he present to 'tenored' aT1 S'ze’ Petichial haemorrhages sub co '
S"ua',on °"
poTsiXSXS"^ ”
■
^73:TXe
o’ -
^enhe"Z rtXSTlT"'
of taeio abdominal oreans.
pathological 0^“^ 'ra“-'■--aebinc.SX’iSf
The descriptive facts m t k
7
fractures etc.
autopsy
F
racts
must
be
recorded
at
•
P y’
ed at Or ^mediately after the
completion of
should be iniftaled,may
Written ”^,orisina,copytoberetaTO4anyaJteratI^
'■ J™of *e taZbe’recoXd f'r'
dead body
Cooetaion
c recorded from appearance of tb.
2. Agcofthe’injuriestobem
3. f-e „f dea b „
P°S mOrtem charSes m the
trauma found
- on the exam^on „f
deS^^
facts of pathology Or
79
MODEL POST MORTEM REPORT FORM
(Read carefully the instruction 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
Date & Time of examination of the dead by
at inquest (as per Inquest Report)_
Name & address of the person
Video recording the Autopsy
Note: The should be duly sealed, signed and dated and sent to the National Human Rights
Commision, Sardar Patel Bhavan, Sansad Marg, New Delhi.
Case Particulars :
1 - (a) Name of deceased and as entered in the jail or police record.
(b) S/O,D/O,W/O
(c) Address
2. Age (Approx):
.Yrs: Sex : Male / Female
j.Body brought by (Name and rank of police officials)
(i)
(ii)
80
I
.7.
of police station
4. Identified by (Names & Add;
iress of relatives / persons acquainted)
“1
(0
(ii)
HOSPITAL DEAD BODIES - (Particulars as per hospital records)
Date & Time of Admission in Hospital
Date & Time of Death in Hospital
Central Registration No. of Hospital
Schedule of Observations :
A) GENERAL
1) Height
cms
(2) Weight
3) Physique - (a) lean / Medium / obese
b) Well built / average built / poor built / emaciated
4) Identification features (if body is, undentifined)
is, undentifined)
i)
ii)
iii)
Finger prints to taken on separate sheet and attached by the doctor.
5) Description of clothes worn- important features.
6) Postmortem charges :
7) As soon during inquest:
8!
-
_Kgs.
8) mortis present
Tempetrature (Rectal)
Others
9) As seen at Autopsy
10)
(a)
External general appearance
(b)
States of eyes
(c)
Natural orifices
10) EXTERNAL- INJURIES :
Mention Type, Shape, Length X Breath & Depth of each injury and its relation to
important body landmark. Dicate which injuries are fresh and which are old and their
duration)
INSTRUCTIONS :
82
Injuries to be given serial numbers and mark similarly
injuries,
(n) in stab i~"
—*-- Mention
' ‘ ■' state of- angles, margins, direcfion^ski^^^^^^
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.
(Wt.
gms)
(d) Orbital, nasal & aural cavities - findings
2 NECK
Mouth, Tongue & Pharynx
Larynx & Vocal Cords :
Condition of neck tissues
Thyroid & other cartilage conditions
- ’ Trachea
Ribs and chest wall
Oesophagus
Trachea & Bronchial Tree
Pleural Cavities
R
L
83
Lungs findings & Wt.
Rt
gms & Lt
gms
Pericardial Sac
Large blood vessels.
4.
ABDOMEN
Condition of abdominal wall
Peritoneum & Peritoneal cavity
Stomach (Wall condition, contents & smell) (weight
gms).
Small intestines including appendix
Large intestines & Mesentric vessels
Liver including gall bladder (Wt
Spleen (Wt
gms)
gms)
Pancreas
Kidneys finding & Wt.
Rt.
gms. &Lt.
gms.
Bladder & urethra
Pelvic cavity tissues
Pelvic Bones
Genital organs ( Note the condition of the 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 (to be opened where indicated)
OPINION
i)
Probable time since death (keep all factors including observations at
inquest)
ii)
Cause and manner of death- the cause of death to the best of knowledge and
belief is:84
a) Immediate cause
b) Due to
' Postmortem and duration if
antemottemV
d) Manner of causation of injuries
e) Whether the injuries (individually or collectively) are sufficient to cause
death in ordinary course
iii)
Any other
Specimens collected & Handed Ov,er (please tick)
a) Viscera (Stomach with contents, small intestine with contents, sample of liver
kidney (one half of each), spleen, sample of blood on guaze piece (dried) any
other viscera, presentative used)
1
y
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 iin cases of poisoning
f) Sample of seal
g) Inquest papers (mention total number & initial them)
h) Slides from vagina, semen or any other material
PM report in original. ------------- _ inquest paperSi drad body_
other articles (mention there) duly sealed (Nos.) handed over to police
official
=--------- ------- --------- --------------Z
of PS
Whose signature are here with
85
No.
Signature
Name of the medical officer
(in block letters)
Designation .
Seal
86
FULL BODY, MALE - ANTERIOR AND POSTERIOR VIEY7S (VENTRAL AND DORSAL)
Name
- Ca:>«’ No.
Date :
?
07
0
r Ul 1 hudy. rr:r.iAi r:. Ari i tznion am> ro’ -11 up hi '/ri.v/r.
/
/
/
1
/
\
\
\
~ X
I
\
\
\
\
ii
/
I
■ I
ii
\
\
\
\
|
I
!
J
J
\
I
ii
\
I
(‘
/
/
I I
I
1
Ma»ru»_____
Cast' Mo.
Da.’e .
ee '
S'
ANATOMY, LATERAL VIEWS
-
I
.I
)
J.
(’/? i i ;
i •<«',
'/
•x.
"
»■
I
l\
I
X
</
Name
Case No.
Date :
09
I
I
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^0
■
(
5
i
APPENDIX ‘A’
INSTRUCTIONS to be followed carefully for detection of torture
(Read carefully the instructions at Appendix ‘A’)
Torture technique Acting
Physical Findings
1. General
Scares, Bruises, Laceration, Multiple
fractures at different stages of healing,
especially in. unusual locations, which have
not been medically treated.
2. To the soles of the feet, or
fractures of the bones of the feet
3. With the palms on both ears
simultaneously.
4. On the obdomen, while lying on a
table with the upper half of the
body unsupported (“operating
table”).
5. To
the
suspension.
head
Haematas
Haemorrhage in the soft tissues of the soles
of the feet and ankles. Aseptic necrosis.
Ruptured or scarred tympanic membranes/ Injuries to external ear.
Bruises on fthe abdomen, Back injuries.
Ruptured abdominal viscera.
Cerebral cortical atrophy, scares, skull
fractures, Bruises
6. By the Wrists
Bruises or scars about the Wrists. Joint
injuries.
7. By the arm of neck
Bruises or scares at the site of binding,
prominent 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 the knees with the
wrists bound to the “Jack”
Bruises and scares on the anterior forearms
and backs of the knees. Marks on the wrists
and ankles.
Near suffocation
10. Forced immersion of head is often
contaminated “west submarine”.
11 • Tying of a plastic bag over the
head (“dry submarine”)
Faceal material or the debris in the mouth,
pharynx, trachea, oesophagus or lungs'
intra-thoracic petechiae.
Intra- thoracic petechiae.
91
Sexual abuse
12. Sexual abuse
Sexually transmitted diseases. Pregnancy ,
injuries to breasts, external genitalia,
vagina, anus or rectum.
Posture
Dependent edema,
extremities.
13. Prolonged standing
Perineal or scrotal haematomus.
14. Forced straddling of a bar (“saw
horse”)
15.Cattle prod.
Burns : Appearance depends on the age of
the injury. Immediately : spots, vesicles,
and / or blakexudated within a few weeks :
circular, reddish mascular scars. At several
months small, white, reddish or brown spot
resembling telangiectasias.
16. Wires connected to a source of
electricity.
Per-anal or rectal bums.
Petechiae
in
low
17. Heated metal skewer inserted in
to the anus.
Miscellaneous
18. Dehydration
Vitreous humor electrolyte abnormalities.
Bite marks
Animal bites (spiders, insects,
rats, mice, dogs.)
92
COMMlmITV ™EDS A=„ approach rai)ER
•J
Sri. G. Prakasham, Demographer
To - wi*.
« .95.^
Karnataka can justifiably be pXer bXe tb^
.“l w PJ°Ud °f
“»>« i"
btrth/shape in Karnataka as Xrfy as in 1930 ih,
“pt of binh control clinic first took
Maharaja of Mysore. By a Xe
Sh»U“ g° “ th'
opening of two birth control clinics one at Chplnv k u
• /
Mnharaja caused the
Vanivilas Hospital at Bangtdore sinceithM
f o?”®1
My“re ““ “o^' at
undergone several changes and in that cotse assSha ed
Pr°®ramme in India has
nutshell the transition of the Family Planning Prno
I number of interventions. In a
following:
7 Planning Pr°gramme from the beginning has been the
1951 :
•
T WOo/^!7 n Ting 33 3 dem°graPhic Programme.
A 100% Centrally Sponsored Programme.
1970 :
Full Voluntary Approach was assigned :
a- Government providing free services
b. Encouraging citizens by Information, Education and
Incentives for achieving the set Targets.
Communication viz.
INCENTIVES :
Cash assistance to IUD acceptors and Sterilisation acceptors.
1980’s :
a. Target based approach continued.
b. Deterioration in the Quality of Services
c. Faulty reporting as a result of quest for achievement of Targets
d. Slow impact on achievement of demographic goals
eeSS?^tedduring™e ’th PLAN (1985-1990)
«r= was need for a closer review ofthe strattgv of senlng up of rhe targets.
1990's: The Sth Plan :
Innovative decisions included :
93
a.
b.
Country from 1st of April 1996.
PP
(TFA) throughout the
c. International Conference on Population and Development, Cairo 1994Recommendations for emphasis on Reproductive and Child Health (RCH).
•
Eligible Couples to decide Family Planning Programme
freely and have
information and means to do so.
cmHa„h (RCH)
A Recommelula,imsfm empkasls o„
•
Decentralised Participatory Planning.
Assessment ofthe needs by grass-root level.
Health Workers involving community.
Renaming of the “Target Free Approach TFA”
as “Community Needs Assessment
Approach (CNAA)”.
Programme to CNAA^
Paradlgm Shift m the Management Policy of the Family Planning
p"“ed vi8°r°"*—
ta
approach was beset with drawbacks
315 11 became apparent thut the top down target
preferences of the clients for the difftent methST F
Sldelining of the
the quality of the FamiJy pi
provided ^th
t0
There was no selection of cases for steHli. . P 'd^d 311(1
foIlow up became casualties
the discontinuation rate of IUD fUsed to be vT
WaS t0 be achieved- Similarly,'
screening women for Reproductive Tract Infections H cSmC n Il4DS W6re inserted without
spacing programme itself suffered.
nfectl0ns and Sexually Transmitted Infections, the
„
TheJ71081 important disadvantage before shift i
^po eve?
ing of
progress for various reasons.
tat
sue'h
"“X ~ ‘
S-TSle
-a survey conducted in India laid bare lower r those indicated by the
f COntraceP^ than
the service
sendee providers
providers. Bui°
But, the real
International Conference
for
Pooulation
anH
n
i
he
rea
^tung
point
was the 1994
-Lice j
that “people have the ability to^enXc^Tan<^held in Cairo which emphasised
teouop pregnancy and child birth^afely the outfo
fertlIlty’ W°men are able to 8°
of maternal and infant survival and well tX Xd ™ i °f pregn^ies is stressful in terms
ree of fear of pregnancy and of contracting dileases”. P
6 t0
SeXUaI relattons
Decision for introduction of TFA based on studies carefully undertaken :
GuidH^^JUndertaken in selected districts.
GnnH t Ga,dellnes for selection of the districts
• Good track records, Female Literacy, infrastructure etc
b- For Condom users no targets were required to b^fixed
istncts with indicators above State average
a
94
(CPR, CBR, performance of Family Planning, Immunisation).
Nado„
“>
children. The implementation of the programme should
It ’
services based on the wishes and needs ofZ etas Sd
mindset of the field level Health functionaries.
°fuyounS women and
\
°f 8<,Od ’“““V
°S al’°“1 1 cha"Be in
ta„’XOd ri “P''i“Kn“ tais “
MandAS^SS^
ery shortly 1996-97, saw the dawn of TFA in entire country.
on an experimental basis i
6
m °ther States’
d"agi"8 J-^ons f«r the
TARGETS”, meant” NO WORK” Sensine this ft nctI0nanes misunderstood that “NO
^rs, Progea^e Ma„age„ F,eld Fu tLteS )'J. b°raKt
with policy
changed to -Cornnttmity Needi Assesfmem A^ta't^n
M^AH™ach was
tvnCrept aat tarSets still exist but that they are^n h. F ./ s 7
the Philosophy-and
Workers themselves in consultation with theTcomntXl" wh^ie S^^1SS■^0<,,
Hea"h
CNAA-IMPLEMENTATION PHASE:
be -SXltCptah“SiV"y eXP'a,nCd in ’ M”“aL The approach is to
PHASE I:
by the grassroots level Hrahh'“nedota” “ThriTsLb’c”)“a dM'n’“lation°ftargets
»d encompasses ah the services to be provtded ta S RChSoXc “
N0''
Based on the Sub-Centre Plans, the PHC/PPC Action Pians are to be complied in
form No.2.
The FRU Action Plans are to be consolidated in form No.3.
Community Need! Assessment ApproaclT5
diStrict on the ^is of
The State PlanfTargets are to be reflected in form No. 5.
dunng January, February, at the Sub-Centre/ViHagelevel
PHASE II :
a
This obviously fl
95
Utmost
31“ March in
aSSeSSments should be done
1.Sub-Centre Monthly Progress Report-Form No. 6
2. PHC/PPC
-do[**
7
3. FRU/
-do“
8
4. Dist/State
-do“
9
One more distinguishable feature of this approach is use of ’ *
of information and
T^chnology ofthe mQdern times. The entire information ’ ' '
i whether it is Action
and National level reports by
96
DOCTOR, CONSUMER PROTECTION AND ADJUD.CAT.ON of LIAB.L.TY
- ------------- ------------------------------------------
The Context :
about Patient’s rights. This
frend is dearly discernible from^re^
or establishment liability. By and large these litinate H
for the suffering caused due to medZl n^
concerning medical professional
timing redressal
sing out of doctor-patient relationship. The controversial <;
of confldentiality
applipat'on of Consumer Protection Actf 1986 (COPJ^. « theT?'
as to
gave fillip to such development.
^UPKA) to the medical profession apparently
economic contexTof rapid decline'of State^Mn?6^
sphere of health care^yste^Id th^ Ind^^^
t0 be aPPreciated in the
Constitutionalize ‘right to health’ as a fimdamental Zr S'"11 u painstaking efforts to
of such
i" a consumer foiirm or^a” reZk? SSur
”ledical Passional liability be it
reMns to negiigenee, vi.iatjo1
Ld ST’PnniipLs
adjudicating forums are caught between e~;.Z
confidentiality. In the process, the
and Amencan legal principles. In view of the^fact these i^
Inierpretations of English
of care, application of foreign principles which am c
fS ^epend on ldentified standers
relevance would undoubtedly lead to arbitrary de eeming devoid °f social and cultural
pattent s or professional’s interests would be inTeotXdTuit
,“i ConSK<uen"’ «ther the
°f PrMeCti"S P’^’s rights wouldXue y
'X
q
y essential to note that the protection nF
,
serious setback. However it is
professional integrity and autonomy ¥he ° is Xi,"', ’
be
the
°f
balance. 01he™se
eonseguenees would be inexpMe’
s™”8 S“ch delicatt
approach. On' o^tath^'S^le'S, X “ ‘ deservi"S "««l for tow.pron.ed
reasonable standerds in the light of social elono^V0^3 identification of minimum
theX T adjUdiC“'s “
i«e tiyl/p
“"tet « would
the other hand, such identification enables SeX
tanderds their day-to-day discharg “ „X' ”
°n “ objective basis On
Passionals to internalize
JoVg^^Xe^
transformatio
the CONSUMER PROTECTION ACT, 1986
protectil^onhTXesIrSr
PaSS£d in 198^with a view to provide for better
of Consumer Pro e t on Cn
. COnS?mers- The Act makes pProtection Councils and othe authont.es such asProvisions
ConsumerforDithe establishment
disputes Redressal
97
settlement of
CO«X “Onal' SB,e and DiS,riCt kVelS f”
SALIENT FEATURES OF THE ACT
a.
to sue the
=~ionrot
b.
c.
It covers not only goods as defined under the scale of Goods Act 1930
.
services including services provided by public sector nnd’Jl0 b 1 S°
government departments such as banking fin^cinn L Undertaklngs
Processing, sopply of electrical or other energy etc.
France, transport,
d.
It defines the rights of consumer: They include:
1.
2.
3.
4.
5.
6.
e.
tte SIV0?6 Pr°teCted againSt the “feting of hazardous goodsthe right to be protected against unfair trade practicesS
the right to be assured access to a variety of goods at competitive prices-
s: „ng;»“xsr "nfair
“ ta“resB ”iU
m
i
It provides for thi,e establistaent of advisory bodies at the central and state levels
to be known as iCentral Consanrer Protection Council and the State oXer
Protection councils with the
object of promoting and protecting the rights of
consumers.
f.
g-
h.
ProvidesTthne1SX di^oTthl Comp'S* C°nS™er
de SS’gS?" mTXZ feiood “ “ith' 0HX?“ Pany “ K“0Ve ,he
and or to pay compensation fifr anv 1 § dS°r t0 retUm
pnce or charges paid
the negligence oHhe Xoshe Zt in"
C°nSUmer due *
services.
opposite party, in respect of defective goods or deficient
i.
•»
It empowers the District Forum, the State
in"th^vent of iteT^to execmeT ' or the National Commission to enforce
-- - or order made by the Court and
to
send
such order to a Court of competent
jurisdiction for its execution.
98
j-
3°zo“ ax:n“of ta~ ■
“Es-io*- ” k.
frivolous or vexatious in the nature. The amount shah
t
PPearS t0 be
10,000/-.
e amount shall not be more than Rs
WHAT a medical doctor shou
LD KNOWN ABOUT COPRA ?
1.
Who can fail a complaint?
A consumer or any recognised consumer association i e voh.nt,
association registered under the Companies Act 1956 nr "
™tary consumer
time being in force, whether the cniKiimpr ic
’ ?56 J
Other law for the
or the central or state government.
a mem er o such association or'not,
2.
Who is a consumer?
Pro™sed or under any
T °f
Services othe'
system of deferred payment and incfude^ ? , d
than the person hires 0^1^Tof fte seticZ^T"
or under any system of deferred navment h
the approval of the first mentioned person
include a patient who merely promises^ pay.
3.
What is a complaint?
4.
What is deficiency of service?
F C0”slderatl0n Paid or promised,
.316 avaiIed of with
H 1S Wde en°Ugh to
law for the time being in force or h^be^
“ ““ i-iv, nature
n?amtained by or under any
person in PMce of a contract otherwise
by ’
comin8 7
5.
Where to file a complaint?
onehiakh of
tefore^e smte^^-COmPensation Maimed is less than
services and the compensation claimed d^ n t°n’
the state commission , if the ^alue oX
t
°f tbe goods or
flVe lakh^
does not exceed more than twenty lakhs of runee"
comPensation
the value of the goods or services and the coT
'
Commi^on, if
lakhs of rupees.
h compensation exceeds more than twenty
99
6.
What is the cost involved in filing a complaint?
There is no fee for filing a complaint or appeal before the different consumer
redressal forums.
7.
Is there any provision for appeal?
Appeal against the decision of the district forum can be filed before the state
th'Zf SIOi’ m the
C°mmission before the nati°nal commission and from
the national commission to the supreme court. The time limit within which the
appeal should be filed is 30 days from the date of the decision in all cases.
8.
What are the powers of the consumer redressal forums?
•
•
•
•
•
•
•
SUmmoning 311(1 enforcing the attendance of any defendant or witness on
oain,
the discovery and production of any document or other material object
producible as evidence;
-J
the reception of evidence on affidavits;
the summoning of any expert evidence or testimony;
the requisitiomng of the report of the concerned’analysis or test from the
appropriate laboratory or from any other relevant source;
issuing of any commission for the examination of any witness; and
any other matter which may be prescribed.
WHAT IS THE SUPREME COURT’S DECISION ?
(1)
dnet
net.
r“dered t0 a patient by a medical practitioner (except where the
free °f Charge t0 CVery patient or
a contract of
na se™ce)> by W of consultation, diagnosis and treatment both
Se'S(W)SXl “““ “
(2)
(3)
(4)
'h' “’h* °f ‘Se™“' “
■"
The fact that medical practitioners belong to the medical profession and are
subject to the disciplinary control of the Medical Council of India and/or State
e ic
ouncils constituted under the provisions of the Indian Medical
Council Act would not exclude the services render by them from "e ^bk o
haS t0 be distinguished from
"a relationship of master and
between the patient and medical practitioner, the service rendered by a
medical practitioner to the patient cannot be regarded as service rendered
c?
°f personal services and is not covered by exclusionarv
ause of the definition of ‘service’ contained in Section 2(1) (O^of the Act. 7
The expression ‘contract of personal service’ in Section 2(1) (0) of the Act
cannot be confined to contracts for employment of domestic servants only ^d
luZ e7eS?10™ld include ^e employment of a medical officer for±l
purpose of rendered by a medical officer to the employer under the contract of
IOC
2(1) (ol of foeWActld bC 0UtSlde
(5)
PUrViCW °f ‘Service’ as defined in Section
to a hospital
/n^7h^
where such services are rendered free of ch-T t 3 hosPltal/nursing home
“service” as defined in Sectioi 2(^ (0 Vfnot be
(6)
whatsoever is made from
^nd poor) are given free se^ice7s om id^
h°me Where n° charge
service’ as defined in Section 2(1) (0 ) of the
°f
exPressi°n
amount for registration purpose only at the ht
u
payment of a token
alter the position.
7 1 h hosPltal/nursmg home would not
(7)
are required to be pafoby foTp^nTavlT1317™?118 hOme Where charges
P-iew of the expression ,eX’ as d^^
(8)
required to beptiJ by perso^who ^efo'apo'f § b0™ Where Ch"®eS
can not afford to pay are rendered service free f T t0 Pay
Persons who
ambit of the expression ‘service’ ^define? 7W™ld faI1 within the
irrespective of the fact that the service h rlie 7
(0) °f the Act
who noun a position to pay for such services
free °f CharSe t0 Person
service” and the recipient a “consumer” under the Act
W°Uld als° be
(9)
Sg? XX' iGm— XXoXTXp“s’’
patients (rich and poor) are given free servi •
expression ‘service’ as defined in Section 261)17 777
°°
serv*ces an^ all
purview of *2
x:nnx“XXra,io"
hoXXxx
of the fact that the serves
Act irrespectiv
(10)
(II)
regarded'XXf ,X
“d4re
”f‘Xhome
medical
practitioner
as taken an insurance policy for medical7 e
consultation, diagnosis and medicXeatmenl
be
the service
Char8es for
t?^011
1
company and such service would fall within tl are bor^e b7 the insurance
m the Section 2(1) (0) of the Act.
h
amblt °f ‘service’ as defined
101
T<M
I
0 74 94
(
■W 4
(12)
Similarly, where as a part of the conditions of service, the employer bears the
expenses of medical treatment of an employee and is family members by a
medical practitioner or a hospital/nursing home would not be free of charge
and would constitute ‘service’ under Section 2(1) (0) of the Act.
HOW ADJUDICATION OF LIABILITY TAKES PLACE ?
When^/J006? bef°rV!ie C°mpetent f°mm Wil1 be Sent in motion in the following manner
When the complainant files a written complaint, the forum after taking cognizance of the
SS'daTltalt0 0PP°Site
3Sking f°r Witten VerSi°n t0 be Submitted
OiitoSdX “"Se’0 Pf0Per
,he fOmm ™“ld
. Let us take situation of medical negligence liability for proper understanding.
DEFINITIONAL ASPECTS
Negligence is simply the failure to exercise due care. The three ingredients of
negligence are:
1. The defendant owes a duty of care to the plaintiff;
2. The defendant has breached this duty of care;
3. The plaintiff has suffered an injury due to this breach.
Medical negligence is no different. It is only that i.
in medical negligence case, most
often, the doctor is the defendant.
WHEN DOES A DUTY ARISE ?
Consider the following fact situation.
Thp Hnrt pnJkred
accident He 1S immediately brought to a doctor B for treatment
tak^^toT ® °b^rVeS
A ls drunk- He reuses to treat the patient on that account A is
iJuries 2n°thf|r doctor who
him- A however does not recover completely from the
thi^c
th He W
t0 carry
Carry SOme f0rm °f disabiIity for the rest of his lifeP Thereason for
injuries.
will have to
this that he was not treated immediately, he would have recovered completely.
Can B said to have acted negligently? The answer to this question to a large extent
depends on the issue whether B owed any duty of care to A.
quesuon’
larSe extent
be contacm7d!^ Aled
d0Ct°r B °WeS 3 duty °f care t0 his Patient. This duty can either
oatient relat*
Or Uty ansing out of'tort law. In some cases however, though a doctorwords of the°s S 1P 13 r*1 establlshed’ the Courts have imposed a duty on the doctor In the
professional oWiaT
* leVSry dOCtOr’ at the govemmemal hospital or otherwise, has a
Kfe wp “ obligation to extend his services with due expertise for projectin'
c^arlv re^St
°f
AIR 1989 SC 2039l- These cases are however"
in mher r
dt “Tf
iS danSer t0 life of the Person. Impliedly, therefore’
n other circumstances the doctor does not owe a duty.
’
’
102
Hence, broadly speaking, the doctor does have a duty to treat evervone wbn
e a duty
to treat
everyone
who
hint for treatment. He has the discretion to either accept
to treat
orre
to ThX
7
apply these pnnciples for the fact situation here in above mentioned The tof
' f’
satd to have acted negligently, since he never owed a duly of “re towmds A 17” !
require him to act otherwise.
7
towards A, which would
WHAT IS THE DUTY OWED ?
bring to his task
words, does not have adhere to the lowest
ac ’ R 1Sc 128)- The doctor, in other
circumstance.
deSree °f care
“-"petence in the light of the
A doctor, therefore, does not have to ensure f
that every patient who conies to him is
cured. He has to only ensure that he makes a resonable degree of care and
-------- 1 competence.
REASONABLE DEGREE OF CARE :
that the degree of care and competence
to have those skill would
exercise in the circumstance in question.”
and the degree Xe' Se siXdS ‘° n°"
bMwra* “»
•he requirement to XoX of taXT' ““ “ 'he
conform to the highest degree of care or the
of care
«
de~me p„" “
what acto'ly ™ XXXXnlXtomX
“d “to refer »
the circumstance.11Itisis“used
to
Thus, though the same standard of care is expected fmm
s
not of any other doctor.
<
‘generalist’ and a
-i are expected to
what amount of reasonable care as
•
t
—' care for the generalist Tn fart
tse the ordinary skill of this speciality and not of and
of
apeeiaiiJX^XXoX^SXX* °
ce of duty on a
doctor. ^XilXuXeXtX^em in th'eX'^’
updating or is it enough to follow what has been traditionally"foIlXc^^’
time, Thl^anXd^Tt'ated deariy'hem kbefo1
reasonableness canges with
reasonable knowledge. Hence, we can conclude tha7a doT^
d0Ct°r possesses
knowledge to meet the standard expected of him Furth t0 Constantly uPdate his
requtred, it may „ot he necessary for him to hnowXiXXX^
105
We have, till now, examined the duty of a doctor in so far as treating a patient is
concerned or in diagnosing the aliment. Doctors are however imposed on, with a duty to take
the consent of a person/patient before performing acts like surgical operations and in some
cases treatment as well. In sum any act which requires contact with the patient has to be
consented by the patient. A duty of care is imposed on the doctors in taking the patient’s
consent. Naturally, a question arises as to what is the duty of care. As per the judicial
pronouncements, this duty is to disclose all such information as would be relevant or
necessary for the patient to make a decision. Therefore, the duty does not extend to disclosina
all Possible information in this regard. Further, this duty does not extend to warning a'patient
or all the normal attendant risks of an operation.
The standard of care required of a doctor while obtaining consent is again that of a
reasonable doctor, as in the other cases.
WHEN DOES THE LIABILITY ARISE ?
Liability of a doctor arises not when the patient as suffered any injury, but when the
injury has resulted due to the conduct of the doctor, which has fallen below that of reasonable
care. In other words, the doctor is not liable for every injury suffered by a patient. He is liable
tor only those which are a consequence of a breach of his duty.
once the existence of a duty has been established, the plaintiff must still prove
the breach of duty and the causation. For, in case there is no breach or the breach did not
cause the damage, the doctor will not be liable.
In order to show the breach of duty, the burden on the plaintiff would be to first show
what is considered as reasonable under those circumstances and than that the conduct of the
doctor was below this degree. It must be noted that it is not sufficient to prove a breach to
mere y s ow that there exists a body of opinion which goes against the practice/conduct of
the doctor. However, in the light of the facts of the case, that there was a body of opinion
supPortmg the course adopted by the doctor, the scope of this judgement wold seem to be
limited. For it is extremely unpalatable that a doctor who is the only one who has adopted this
0Wn agamSt 3 b°dy °f medical opinion- The ^Plications of such a
stand would be high y detrimental. Further, as doctors are entitled to rely on general practice
wheZedSff JT’ T'' W°Uld
merit In denying thC qU31ity of m^ableness
wnen tne plaintiii seeks to rely on it.
the fact^T^^
'S 3 b°dy °f °pini0n in favour of the conduct the doctor,
conriX H
-1S 3 b°dy °f °PiniOn C°ntrary t0 the conduct of the doctor must be
considered as sufficient to prove the breach of duty of care.
regard to causation the court has held that it must be shown that of all the
He'nce ‘fth50115
°f dUty °f the doctor was the most Probable causes
”e° h’j XTe
7“’“ °f "
” 'he "eS1‘ge"“
,hlri
or
breach of duty of care of the doctor wag the most probable cause of the injury to discharge the
burden ofproofon the plaintiff.
B
patient or the leg amputate instead of being put in a cast to treat the fracture, the principles of
104
XSET ““,C) "*
1.
2.
Complete control rests with the doctor.
It is general experience of mankind that the accident, i
■, in question does not happen
without negligence.
This principle is often misunderstood
as a rule of evidence, which it is not. It is a
principle in the law of torts. When this
doctor/defendant to explain how the incident
apply this principle freely in case of
up®Cexpert X “?o Wpfaa
:XP" “
»as fa ^farij, \X
~ =-^
== “
v'rfa..,, exempting ntefaai eases XXppiXn^PXnXoXp”'
l»bility).boX; inXcase^a do«o' cm feXlSXtXsX 1 V'Cm0“S
Xfa rr ”X“ wh“ “p°—z
“
breached4duty. AfaXXXs"fatal7 'h'
Of a surgery. If a junior doctor is involved as part of the tea^ then h JT1S ? 6
exercise of the specialist skill is concpmeH ;c t
i ?
th hlS duty’ 33 for 33 1116
have discharged his duty once he does &is’aLd wm
h
Help °f 3 Senior- He wiI1
the act which causes the injury it^a
if he actuaI1y commits
properly. If he did not do so.Zn he would beX 2 X X foX"0patient, though he did not commit the act.
responsible for the injury caused to the
WHEN THERE IS NO LIABILITY ?
an mjuXi^XX fae7 »fa fa.'XiX ‘
h“
breached fa duty of care. In fa section fa Ufa
“heV^
” •b* he h“
due to the doctor but the act does not amount to a breach of du^' ifaxptfadL “
aspect in question. Fm’exmpid'docfa nomS" med,cal Profession as regards a particular
This is normally considered bv’ courts
• y,Use a stethoscope to listen the heartbeat,
situation.
C°UrtS 3S 3n mdlcator Of what is reasonable in a given
The main issue in this
area is whether general practice is
conclusive proof as to
reasonableness?
103
Though the courts have not categorically accepted it as conclusive proof, though they
have not denied it either, in relation to medical negligence cases. Further, in numerous cases
the courts have accepted it is proof the courts have held in relation to other professions that
general practice not conclusive as to reasonableness.
• ^nother factor t0 be considered in the analysis is that ultimately it is the court which
must judge what is reasonable and what is not.. It cannot delegate or give up this function in
favour of someone else. It is appreciated that due to technical nature of the subject, the judges
may not be able to accurately judge the nuances.
Error of judgement can either be a ‘mere’ error of judgement or error of judgement
due to negligence. Only m the case of the former, it has been recognized by the courts as not
-e.!n.g.a breach of 1116 duty of care-can be described as the recognition in law of the human
fallibility in all spheres of life.
A mere error of judgement occurs when a doctor having only considered, makes a
decision which turns out be wrong. It is situation where only in retrospect, an be say there
was an error. At the time when the decision was made, it did not seem wrong. If, however
due consideration of all the factors was not taken, then it would amount to an error of
judgement due to negligence.
An example of a mere error of judgement could as follows:
A patient has symptoms which are indicative of two different diseases ‘X’ and ‘
after conducting due tests, there is no evidence to show that the disease is either ‘X’ or ‘Y’
but only that it is one of the two. At this the doctor decided that the disease is ‘X’. Hence he
reals the patient for this disease. It later turns out that the disease was ‘Y’ and the treatment
given was actually injurious. If the doctor had been more experienced he might have been
able to make the correct decision.
In this case, due care had been taken to conducting the required tests. It was only in
retrospect that one could conclude that the decision of the doctor was wrong. Thus it was a
mere error ofjudgement and the doctor would not be liable for the injuries caused.
WHETHER A DOCTOR CAN DEPOSE BEFORE FORUM ?
eV,denC' “
citer
X™c«E^ISLraXriSSUEs7HE
°F CONSUMER
“ deP°Se
TO
One significant information which is required to be noted is that the above principles
me. ica negligence liability have been evolved by the regular courts of law mainly
premising on English and American principles, that too, after detailed scrutiny of adducible
consi11^’ Time 1^ agam’ tHe Nation?1 Consumer Redressal Forum has observed that if a
liaht^fdetailTd ‘a PertaiI?ln§ t0 medical ^g^gence is required to be adjudicated in the
court f d
d
denCe’the consumer forum is not the proper forum but of a regular civil
106
Needless to say, in the ambit of T
Consumer Protection and Adjudication of
Liability’ this issue deserves
---------- seri
serious consideration by one and all.
Standardization of professional care, is it a solution?
J
107
KARNATAKA HEALTH SYSTEMS DEVELOPMENT PROJECTACCESS TO WOMEN’S HEALTH AND REFERRAL PROTOCOLS
Dr. G. V. Vijayalakshmi, Consultant, KHSDP
Karnataka Health Services provide all the health services in the State as elsewhere in
India at three levels namely
1.
2.
3.
Primary
Secondary and
Tertiary
Primary Health Care received considerable attention and resources through the State’s
own funding and also through external agencies thorough various IPP Projects. So also the
Tertiary Hospitals are fairly well developed in Karnataka with more than 19 Medical
Colleges in the State with their attached hospitals are being utilized for clinical facilities
Whereas secondary level of health care hitherto neglected so far has been recognized now by
the Government of India and the World Bank authorities & hence the Karnataka Health
Systems Development Project aims at improving the infrastructure and modernizing in
delivering the quality care services by the secondary level hospitals based in rural areas of
Karnataka State.
_ The Secondary Level Hospitals are of various types and magnitude with marked
disparity in the availability of infrastructure and the quality of services provided by these
hospitals and it varies in different areas of the State. So the need for the referral network of
the Secondary Hospitals which is only an organic extension of the primary health care
system. Secondary Health Care is now being recognized all over the World and thus the State
Health Systems Development Project I & State Health Systems Development Project 2
came into existence State Health Systems Development Project 1 covers Andhra Pradesh
State and State Health Systems Development Project 2 covers Karnataka Punjab & West
Bengal States in India.
KHSDP covers 201 rural hospitals 107 of which are sub-divisional hospitals and 74
are community hospitals or CHCs in 4 divisions of Karnataka except the Gulbarga Division
which is covered under KfW project.
Land Marks:
1. Pre Project Activities
December 1994
2. Preliminary Project / Project Plan January 1995
3. Workshop
28th February 1995 to 1st March 1995
<♦ Project Preparation Committee
Norms for hospital Facilities & Services
High Level Committee
Project Preparation Committee was headed by Mr. Sanjay Kaul IAS, Additional
Secretary for Health with Dr. S. Kantha, Director of Medical Education, Dr. M.T Hema
Reddy, Director of Health & Family Welfare Services and other various Additional & Joint
Directors of the Department.
103
Establishing Norms for Hospital Facilities & Services Committee
was formed by
various working groups namely:
1. Medical
2. Surgical
Medical Group was comprised of
3. Diagnostic Groups
g Si:sxsasss:ofPri“
c) Neuro Physicians & Psychiatrists from premier Institutes
d) Pediatricians from Medical College Hospitals
e) Forensic Medicine Experts
f) Experts in Preventive Medicine
g) District Surgeons
'h) Physiotherapists
i) Chief Nursing Faculties
Surgical Group formed a huge working set up headed by
a clinical expert with wide
hospital experience and Administrative Officer supported by
a) General Surgeons
b) Obstetricians & Gynecologists
c) Orthopedic Surgeons
d) ENT Surgeons
e) Ophthalmic Surgeons
f) Dental Surgeons
g) Anesthesiologist
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 is included
a) Bio-Medical Engineers
b) Health Equipment Specialists &
c) Training Experts from ASCI, Hyderabad
Diagnostic Group which included
a) Pathologists & Bacteriologists
b) Radiologists & Sonologists
c) Bio-Chemists
d) Micro Biologists
e) Laboratory Service Experts
f) Senior Technicians &
g) Nursing Assistants from Government & PrivateSectors
109
Simultaneously different Sub-Committees with various disciplines were formed and
the teams visited hospitals of different categories in the State for RTNA study (Rapid
Training Need Assessment). The teams studied the requirements for training Clinical NonChmcal, Diagnostics, Pharmacists & Hospital Management Training aspects. Through out
the workshop there were observers from the World Bank and Officers from other States to
Punjab & West Bengal.
All the committees submitted their report to the Government.
Thus the final Project Proposal of KHSDP was submitted to the World Bank in
September 1995.
♦ UIt™a^ely the “Project Launch Workshop” was inaugurated by the Hon’ble Ex-Prime
Minister of India Mr. H.D. Deve Gowda on 27“ June 1996 a Red Letter
T
~ for Karnataka
"
Day
State. This was followed by an extensive workshop for 3 days
. > on various aspects of the
project, participated by
1. Health Secretaries from Government of India
- ' '•
2. Health Secretaries from 3 State of Karnataka, Punjab & West Bengal
3. Health Secretary from Andhra Pradesh to guide the junior projects
4. Sri. Pradeep Puri, I.A.S., Project Administrator of KHSDP & E/o Secretary to
Government.
fU Jhc Worksh°P was aIso participated by Senior Administrative Heads of Directorate
& w“'Bensa',o di“uss ,he
Salutations and remembrances to the following officers & officials who worked for
pre project activities & preparation of project proposal.
1. Mr. Gautham Basu, Health Secretary to Government of Karnataka
2. Mr. Sanjay Kaul, Additional Secretary to Government of Karnataka
3. Nir. D.V.N. Sarma of STEM, Government of Karnataka
4. Innumerable Officers of various cadres of Clinical, Administration, Statistical
sections of Health Department.
Implementation of the Karnataka Health Systems Development Project (KHSDP):
.... KGSDP office has been established in the premises of Public Health Institute
Building on Seshadri Road, K.R. Circle, Bangalore!-l.-
WelfareDeolrtmen? PB’- E*'?5aPpa’ LA'S” Secretary to Government, Health & Family
Zilka dT?\\ °Je AdTTeStrJtOr & E/° Additl°nal Secreta^ t0 the Government of
amataka. Dr. S. Subramanya, I.A.S. heads the entire Project Team. He is assisted bv Chief
Admmistra.ive Officer, Chief Finanei^ Officer, Under sLe.ary, ere.
in
no
Engineers, AssistL" EXX^L^tlrTTS!XntdEan2iSted hV’5
with other ministerial staff.
°f Superintendent
Engineers, Junior Engineers etc. along
’
t.
Deputy Chief Architect heads the team of Architects in
preparation of plans, etc. for
construenon of hospital buildings with technical emphasH
Medical Wing constitute of:
by us&
L
conducts research studies
8y’
°r ‘nateS health sector Planning and
Iy ? X
2
a-
a.
b.
the District Hospitals.
Hospitals and CHCs by the TOTs in
c. Specialists training at super specialty hospitals under taken at
i. Jayadeva Institute Cardiology
n; Indira Gandhi Institute of Child Health
Medical College
.
The training programme will be further
extended in other premier institutes for
vanous other disciplines.
^privXXxXXXakena, major District Level Hospitals in Government
to be
29j21”7
& C1,OTical Analysis of water is
conducted at Public
CumuMv. Status Report of various training components are as Mows:
Hl
Karnataka Health Systems Development Project, Bangalore
Training Status as on 31.03.1997
Trained
1. Trainers Training at St. John’s Medical College, Bangalore (Doctors)
2. Masters Trainers Training by JIPMER, Pondicherry Staff (Doctors)
3. District Level Training to CHC / Taluk Level Doctors
82
20
11
Training Status as on 31.10.1997
1. Trainers Training at St.John’s Medical College, Bangalore (Doctors)
2. Masters Trainers Training by JIPMER, Pondicherry Staff (Doctors)
3. District Level Training to CHC/ Taluk Level Doctors
4. Sr. Laboratory Technicians Training at PHI in Water Testing
5. Nurses Training at Teaching Hospitals
6. Training of Technicians attached to Equipment Maintenance Wing
at Hyderabad
7. One day workshop in Hospital Waste Management
8- Training to Orthopaedicians at Sanjay Gandhi Hospital, Bangalore
9. Training to Pediatricians at Indira Gandhi Institute of Child Health
10. Training to Physicians in ICCU at Sri. Jayadeva Institute of Cardiology
26
20
101
15
188
36
20
03
12
13-
Cumulative Training Status as on 15.11.1997
1. Trainers Training at St. John’s Medical College, Bangalore (Doctors)
2. Masters Trainers Training by JIMPER, Pondicherry Staff (Doctors)
3. District Level Training to CHC / Taluk Level Doctors
4. Sr. Laboratory Technicians Training at PHI in water testing
5. Nurses Training at Teaching Hospitals
6. Training of Technicians attached to Equipment Maintenance Wing
at Hyderabad
7. One day workshop in Hospital Waste Management
8. 3 days conference in Trauma Anesthesia & Critical Care
9. Training to Orthopaedicians at Sanjay Gandhi Hospital, Bangalore
10. Training to Pediatricians at Indira Gandhi Institute of Child Health
11. 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
108
40
112
15
249
36
20
20
03
11
18
05
04
02
02
Status Report on Civil Works as on 10.11.1997
Total No. of Hospitals included in the project
No. of Hospitals so fare assigned to Architects
(No. of Architects involved 46)
? ?
No. of Hospitals for which preliminary designs are cleared by World Bank
112
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
Biddmg documents awaiting approval of World Bank
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
01
and cleared subject to modifications to be verified by BSC
review^
reVieWed by
World Bank Architect and to be
eviewed by him after modifications are carried out
Preliminary designs under perepartion etc
No. of hospitals yet to be assigned to the Architects
26
04
69
11Grand Total
201
Objectives of the Training Programme :
improve quality and strengthen the
pb:oZ°sVide
“S •»
-He aMity of
Management training has been focussed on
1. Facility Management
2. Personnel Management
3- Maintenance
Recruitment Procedures
Rules and Regulations
Supervisory Techniques
Disciplinary Procedures
Motivation
Team Building
Group Dynamics
Training & Development
Planning for preventive maintenance
Maintenance of Buildings
House Keeping
Monitoring of use and abuse
Hospital / Medical Waste Management
4. Finance
Government Financial Procedures
Budget Planning
Procedure & Practices of Accounting
System
Budget Monitoring and Control
Internal Audit &
Management of user charges
5. Procurement Matters
Procurement procedures, rules &
regulations
6. Consumable supplies including
Drugs Management
Planning for the supplies
Procurement
Inventory Management
Usage
Monitoring the Storage
7. Information System
The use of information to improve hospital
management
Importance of patient’s registration
Medical Records &
Medical Reporting
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 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 subdivisional hospitals with updated beds of 50 -100 &
district hospitals with beds 250 - 800.
These hospitals provide Out-patient, In-patient 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 1*than 500 beds provide
specialised services and these hospitals come under the
control of Directbrof Medical Education.
114
quality medicare
can be provided only when a
5
proper and effective referral system
IS FORMULATED AND IMPLEMENTED
Current Referral system :
No definite system is existing
PHCs - Inadequate quality of services.
• CHCs - are often bypassed
Tertiary - are unnecessarily overburdened.
New Referral system :
•
Renovating & upgrading of hospital buildings to nrovidp
services
r
vuuuings to provide appropnate space
Upgrading and updating clinical skills of Medical Officer. .mH
effective training programme.
Officers and nurses through an
Providing ambulances for transporting critical patients and
Installing phone, fax / radio communication.
CHCs will become the
Referral units for Primary health care
Referral System under KHSDP :
'
Xd'S
lbe °fw of hospital as pet
service
secondary hospital facilities before
opting for tertiary hospM. ”Se pnman'
A Referral Card is used whenever a patient is referred.
Measures contemplated are
•
Referral and feedback cards are being introduced
“
implementing the referral
,l”' SP“i<y the Wh“ &
• liSel 0?“"“ Wh0
r,!fOTal systcms is
Facilities throuXZ’ar XltaS ouwach risS Mng
•
Intensive IEC targeted at nrnvia.
a *1.
■. ............ ............................
115
-
1SItS a e bung established.
Referral Network:
•
Zoning of each district
•
Referral Chain
PHC
CHC
TLH/SDH/DH
TH
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 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 ofReferral System : Ex-pilot Chitradurga District Hospital
Use ofService Matrix - Referral Protocol
Receiving of the Referral Patients
Place Earmarked
1. Queue Jump / Treated on priority
2. No. of OPD ticket, Referral Card itself is used as OPD ticket
116
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 alternatives is
possible, cost will be reimbursed by KHSDP through the District Surgeon.
5. Accommodation of patient party 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.
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
Administrator^ KH°SDpre^Uirenlent ‘ cl"i'icati<,n "
s“k ““ Actions from the Project
Training Programmi:: is organised by District Surgeons for all categories of staff
orking in all the hospitals & PHCs in the Districts as per needs.
District Surgeon sends monthly report to the Additional
Project Administrator of KHSDP.
Director (Medical) and
Any technical suggestions from senior officers of DH & FW
may be taken into
account by the District Surgeon.
Referral 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
'i
Referral System is only a Tool to provide
best Medicare and''
Not Shirk Responsibilities
4. Non-emergency / cold patients should make own arrangements for transport. But
information and broad guidelines are to be given and they are treated in regular
OPD hours.
Critically ill patients / emergencies
are attended round the Clock
On-duty Medical Officers are empowered to make reference to higher hospital
following the referral procedure.
Improvement of Access to Health Services for Women -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.
3. Screening and treatment of Gynecological 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 gender discrimination and
violence through “Engendering & Empowerment”.
II Phase
Additional interventions are:
6. Management of problems associated with onset of menarche and menopause
7. Screening and treatment of Breast Cancer
8. Prevention & Treatment of Infertility
113
The above range of services have important health (components requiring
interventions which are much beyond the scope of the department,• Here, the envisages
support to the primary health care sector by providing technical services referral services and
financial assistance.
The programme covers all the women from 10 to 60 years. The ANM will identify
susPected( Cases for each type of disorder/disease among the target groups shown in the
tables by Syndrome Approach” and referred to LHV/MO of PHC for detailed checkup and
treatment or referral if found necessary.
Role of Doctors in Implementing Project Activities and their responsibilities :
•
•
•
Doctors
Implementing Project Activities
Moral Responsibilities
IIS
Maternity Care with Focus on Hospital Delivery
• Elements of Maternal Health Services
• Maternal Mortality / Morbidity
• Delay Child Bearing
• Every Pregnancy Faces Risk
/• Ensure Institutional Deliveries / Skilled Attendants at
Delivery
• Improve Access to Maternal Health Services
• Improve quality of Maternal Health Services
120
<
maternity HEALTH SERVICES
Every year, 200 million women become pregnant and 15% are
hkely to develop complications that may lead to patient’s death
or
serious illness.
All Women whether their pregnancies are complicated or not need
good quality Maternal Health Services, which must be
• Accessible
• Affordable (Cost efficient)
• Effective
• Appropriate and
• Acceptable
121
ELEMENTS OF MATERNAL HEALTH SERVICES
Antenatal Care : The World Health Organization recommends
pregnant women should have four antenatal visits for :
• Health promotion : advice on nutrition and health care, as well
as counselling to alert women to danger signs and help plan for
" the birth;
• Assessment : history taking, physical examination, and
screening tests;
• Prevention : early detection and management of complications,
and where needed, prevention of malaria, hookworm and tetanus
and early referrals whenever necessary with referral cards ;
• Treatment : management of sexually transmitted diseases,
anaemia, or other conditions.
122
8-
Delivery Care :
birth who can :
WHO recommends a skilled attendant
at every
• Provide good quality care on an
hygienic, safe and sympathetic ongoing basis; care should be
• sji.ics.sr
Refer promptly and safely when higher-level care is needed.
.MS”
■ WH°
/
’ nlwbom;tiOn
management °f Problems in ™ther and
• Counselling, information and services for family planning; and
•Health promotion for the newborn and mother, including
immunisation, advice on breastfeeding and safesex.
123
MATERNAL MORTALITY
A Global Scourge
Worldwide, there are 430 maternal deaths for every 100,000 live
births. In developing countries, the figure is 480 maternal deaths for
eVery 100,000 live births; in developed countries there are 27
maternal deaths for every 100,000 live births.
124
i
These maternal mortality ratios reflect a woman’s risk of dying
each time she becomes pregnant; because
women in developing
countries bear many children and obstetric care is poor, their lifetime
risk of maternal death is much higher - almost 40 times higher than in
the developed world.
/
----------- -------------------------------
Women’s
All developing countries
-
All developed countries
1 in 48
1 in 1,800
125
Institutions should offer clean delivery by skilled personnel,
prompt recognition of complications and appropriate referrals with
stabilisation of the patient till she is transferred safely to the next level
of care.
A functioning system of communication and transportation
between all levels of health system is essential for the appropriate
referral and the use of obstetric services.
126
t
CARE FOR MOTHERS
1 ■ Ante-natal care and identificatio
n of maternal complications
2. Immunization (against Tetanus)
3. Deliveries by trained personnel
4. Prevention and treatment of anaemia
/
5. Promotion of Institutional deliveries
6. Provision of Emergency Obstetric Care (EmOC) services
7. Birth spacing
127
DELAY CHILD BEARING
First birth can be delayed by postponing the sexual activity and by
using effective use of fertility regulation. Education and employment
opportunities play a critical role as alternatives to early motherhood.
As agreed upon at the 1994 international conference on population
and development in Cairo, adolescente’s & sexual reproductive health
f
/
needs should be met with appropriate programmes which provide
information counselling and health services.
128
every pregnancy faces risk
Maternal risk is defined as the
probability
of
dying
-uzxxilj
ui aymg
expenenemg serious injury „s „ resuk of
j-
D^ sugges. 40% of
• »
pre8„mt wome]1 have some
or
and
the pregnant women need obstetric care for managing
oompheatrons which are potential life threatening to mother or „,fa„t
And such complications are often sudden in onset and unpredictable
I
129
ENSURE SKILLED ATTENDANTS AT DELIVERY
Skilled birth attendance are defined by the WHO as trained mid
wives, nurses, nurse / mid-wives or Doctors who have completed a set
course of study and are registered or legally licensed to practice. But
Traditional Birth Attendants (TBAs) are not trained to deal with
complications but have a vital role in supporting women during
labour.
130
(I
BARRIERS to care
• Distance and lack of transport
• Interactions with providers
• The gender dimension / Socio-cultural factors
I
131
THREE DELAYS INCREASE THE RISK TO A WOMAN’S
LIFE DURING PREGNANCY
DELAY
in deciding to seek medical care
DELAY
in reaching a medical facility with
adequate care
DELAY
in receiving quality care at the facility
/
132
improve access to maternal health services
Access means that maternal health care is within the reach of
women who need ,t. The proportion of pregnant women who have
care during deiiver, is u„,Versally iower thm
antenatal care. Yet it is during labour, deliver, and the immediate
post-parlem period that complications are most likely to arise and that
care .s most needed. A,most htdfof al! post-partem deaths take piece
within 1 day of delivery and 70% within the first week.
133
IMPROVE THE QUALITY OF MATERNAL
HEALTH SERVICES
Good quality maternal Health Services are those which meet the
following criteria :
• Accessible and available at the lowest level facility with
effective and safe services.
• Acceptable to potential users in response to cultural and social
norms such as preferences for privacy, confidentiality and care
by female health workers.
• Have on hand all essential supplies and equipment.
• Provide comprehensive care and follow up.
• Staffed by technically competent health professionals.
134
national health programmes, their objectives and
implementation
and
Dr. KB. Makapur, Director, SIHFW
blAtin Tn Nati°nal Health Programmes ;
are formulated and launched by the Central or
“ iraPr°Ve ,h‘ Hea"h “f •»'
. . : on specific health problems after
Objective ofNational Health Pn
------ ’ogrammes
1. To control / eradicate the communicable diseases
2.
3.
To control the
S"i“0" ““
Jo Z™
™.er
™ICEF,
National Health Programmes
1. National Malaria Eradicatio
n Programme :
Malaria was and is one Cx~
°f'he
>» I«0-s i,
nimber
one Public Health Problem in India
As per 1953 estrmates yearly incidence was 75 million
cases with 8 lakhs deaths
a centrally sponsored program^to redlc^ the morbid1^t60^01
in 1953
as
Malaria incidence was brought down to 2 million cases S 1958 fr
t0 MaIaria. The
• The Central Government ungraded tfop- «
m3 from 75 million cases in
due to malaria, to reduce morbidity and moXht> d' P
°Peratl°n’ to Prevent deaths
reduce morbidity and
NoLlTt01
field °f Agdcultme and C rfes To
k
* maintain the
North-East regxon, a special programme vi
X T° "Ontamrthe PF incidence
the
---- in the
programme was launched includina the
’ plasmodlum falcifarum
to contain the spread.
" thedru= resistance problem. The guideline. containment
s are changed
135
Activities :
1) Attack on the parasite - prompt case detection by active and passive surveillance
and prompt treatment and reduce the reservoir of infection.
2) Attack on Vector i) Bioenvironmental method of vector control.
ii) Indoor insecticidal spray with appropriate insecticide as approved by the
Central Govt.
3) Awareness campaign regarding the malaria, causation spread, signs and symptom,
diagnosis and treatment and prevention.’
The programme is implemented through the following.
State Head quarter - A cell is established - 1
Divisional Level - Deputy Director NMEP Zone - 4
District Malaria Officers -20 + 7 (New Dists.)
Primary Health Centes - 1601 and
All other health institutions, Drug Distribution Centres and Fever Treatment Depots.
Strategy:
1) Surveillance - Active - Jr. H A (M), Jr. H A (F) & Sr. H A (M & F)
- Passive - All Medical Institutions
- Mass and Contact.
2) Laboratory Diagnosis of cases
3) Prompt Radical Treatment of cases
4) Operational Research - Vector behaviour and sensitivity to insecticides
- parasites’s sensitivity to chloroguine.
The malaria incidence year wise in the state is given in the Annexure.
2. National Filariasis Control Programme :
Filariasis is another public health problem in India. About 304 million people are
exposed to the risk of infection and 15 million people with menifest disease and 21 million
people are having micro filaria in their blood as 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 NFCP:
1) Delimitation of problem in the unsurveyed areas,
2) Control in the urban areas,
Recurrent Antilarval measures
i)
Antiparasitic measures with DEC.
ii)
In Karnataka the problem of filariasis is seen'tn the districts of Dakshina Kannada,
Uttara Kannada, Bijapur, Gulbarga and Bidar.
136
i»n of this p„!nMt:
(7
2) National Filaria Control Units - 8
3) Filaria Night Clinics - 25
4) Filaria Survey Cell - I
The programme is in operation in the problem districts - The Government of India
PP ies the equipments and materials and rest is met by State Government.
3. National Family Welfare Programme :
Government of India i
Jn0over
-08"181the
.118 the neeJ of Population control, launched Family
Welfare Programme in 1952 all
country becoming first country in the World to do
SO.
Mile Stones ofProgramme Development:
-
G»v« ™ Birth Centro! ciinics
inics started
SMe<i in
in 1930
1930 in
m
-
National Family Planning Programme launched during 1952
princdy
of
Actmttos ; . Mistaeot of few cllnics to pro
Distribution of education materials
- Training and Research
' Pta®'9^“' 'iPP'°aCh ,0 “'X,e"S™
- tatrodX™ f WnHe
a“ep,a"ce
aPPra»ch” in 3«
five year
Small Family Nom
uuucuon or 1UD in the programme - in 1965
State and District Bureaus) 1966-69 ’
e’Urban Family Planning Centres,
Top pnonty PJ°g™nm<-> - during 4th five year plan (1969-74)
PHCs/Subcenfres Pr°gramme became integral P^ of MCH Activities of
■
~
was renamed as “FaSfiy WdfaS’’’07
by Janatha Govt 311(1 Ministry
Population Control and Family Planning ic •
- K=aassa5=
through Primary Health Care.
d 1: was approved in 1983 by th,
. he Parliament and brought into force.
Long Term Demographic Goals set in the p,
'opillation policy to be achieved by 2000 AD :
1) N R R . 1 (2 child nonn) ' '
3 i n rt!lRDate ~ 21 Per 1000 Popniadon
) Death Rate - 9 per 1000 population
5> §7Re-i?sXTte’60”dabo’'perl0°
137
The Family Welfare Programme was a target oriented and time bound programme,
but implemented on purely voluntary basis. During 1995-96, the programme was made
“Target Free Approach” and there was set back in programme implementation in many state.
The same is now renamed as “Community needs assessment approach” where the Jr. H A (F)
prepares the estimates of the Community needs for each services for the subcentre area. The
same is compiled for all subcentres of PHC that will be the community needs estimate for
PHCs for the year. The action plan will be prepared for PHC accordingly.
Services provided :
- Contraceptive Advances & Services
- Termial methods / permanent family welfare methods
-1 E C Activities
4. Reproductive and Child Health Programme :
i) The Family Planning Programme was started in 1951 as a purely demographic
programme. Subsequently the element of public education and extension wing
included to facilitate outcomes under the Family Planning Programme. During the
seventies, the Family Planning Programme was focused mainly on terminal methods
and programme received set back due to rigid implementation of a target based
approach. The programme has, however, remained fully voluntary and the main
effort of Government has been to provide 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 of population which led to change in the approach from Family Planning to
Family Welfare. Since the Seventh plan implemented during 1984-89, the Family
Welfare programmes have evolved with the focus on the health needs of the women
in reproductive age group and of children below the age five years on one hand and
on the other hand to provide contraceptives and spacing services to the desirous
people. The main objective of the Family Welfare Programme for the country has
been to establish population at a level consistent with the needs of National
Development.
ii) The Universal Immunisation Programme (UIP) aimed at reduction in mortality and
morbidity among infants and younger child due to Vaccine Preventable Diseases was
started in 1985-86. The Oral Rehydration Therapy (ORT) was also started in view of
the fact that diarrhoea was a leading cause of deaths among children. Various other
programmes under Maternal and Child Health (MCH) were also implemented during
the 7 Plan. The objectives of all these programmes were convergent and aimed at
improving the health of the mothers and young children and to provide them facilities
for prevention and treatment of major disease conditions. While these programmes
did have a beneficial impact but the separate identity for each programme was causing
problems in its effective management and this was also reducing somewhat the
outcomes. Therefore, in 90’s in the 8th Plan, these programmes were integrated under
Child Survival and Safe .Motherhood (CSSH) Programme and which was
implemented from 1992-93.
iii) However, the position is not uniform all over the country whereas the State like
Kerala, Tamil Nadu, Goa, Maharashtra and Punjab have achieved a considerable
higher level, the States like U.P., M.P., Bihar, Rajasthan, J & K., Assam and Orissa
138
i
^h”“e%“osw± nhational lev:L ™s has b"n *
/.
V
»f
P«rfo™a„ce In ,hese sSl im‘?ves 2’^" “I b'
P<,p“tous
remain depressed. The results at^rounH I ?atI0nal Performance will continue to
like investment for the programme at ^6^ are influi;nced b7 a number of factors
Health System and response^ the people The H
efficienc7- of the State
material and child health serviceZhave he H d flC,en^.es ln imPlementation of the
maternal mortality and child 7Tnf2 ZoXm resP0,nsiblue for a high incidence of
children. Poor prospect of health and life ofth11
heaIth StatUS °f women &
factors leading to birth of more children per family Vh/211
0116 °f the prominent
past levels of various RCH and population indir Y' — Present position vis-a-vis to
ano population indicators is given in the following table :
Achievements and Goals:
Indicator
Past levels / achievement
Infant Mortality Rate
~~
Crude Death Rate
Maternal Mortality Rate
Total Fertility Rate
UfeExpectancvat Birth (Years)
146(1951-1961)
25.1 (1951)
NA
6.1 (1951)
Male
Female
Crude Birth Rate
Effective Couple Protection Rate
IfflmumzationStatus(% Coverage)
37.1 (1951)
36.1 (1951)
40.8 (1951)
10.4 (1970-71)
T T (for pregnant women)
Infant (BCG)
Measles
40(1985-86)
29 (1985-86)
44(1987-88)
National Family Health Survey 1992
-93
iV> b~XX^
“
Current Level
72 (1996),
8.9 (1996)-
■
'
4.37 (1992-93)
3.5 (1993)
61.5 (1996)
62.1 (1996)
27.4 (1996)
46.5 (1996)
76.73 (1996)
93.12 (1996)
78.91 (1996)
C— has
severe handicap particularly when it is nZed tS
f
This is a
care system needs upgradation and it needs breach oZt
3 reSpeCts> the health
national goals to be achieved While the, h OUttoipany more people for the
steady improvement due
performing s,ates md m regard t0
“‘‘“Im ”lh ““ imP1<!™™ion
of the CSSM
Conference On PopuIation and DeveL^f fn J’
International
Reproduction and Child Health (RCH) Tb- pru
Cair° ' recommended for
People have the ability to reproduce aid rZr 75 m aPpI°ach has been defined as
go through pregnancy ^epchiidc b^h
wfmen
abie "°s
successful m terms of maternal and infant sZS
outcome of pregnancies is
.0 have
re,ations free of fcar of pre^X"
139
This concept is in keeping with the evolution of an integrated approach 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 would help in reducing the cost of inputs to some extent because
overlapping of expenditure 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 the beneficiaries need based client centred
demand driven high quality and integrated RCH services. The RCH Programme is
a composite programme incorporating the inputs of the Government of India as well
as funding support from external donor agencies including World Bank and
European Commission.
vi) It is a legitimate right of the citizens to be able to experience sound Reproductive
and Child Health and therefore the RCH Programme will seek to provide relevant
services for assuring Reproductive Child Health to all citizens. However, RCH is
even more relevant for obtaining the objective of stable population for the country.
The overall objective since the beginning has been that the population of the country
should be stablilized at a level consistent with the requirement of national
development. It is now well established that parents keep the family size small if
they 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 simultaneously strive for obtaining
Reproductive and Child Health arrangements for the whole of the country’s
population and to promote and make available contraceptive / terminal methods for
desirous couples. It also needs to be observed that the measures through the health
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 :
a) Policy support expressed publicly by opinion leaders in different sectors
the national system and by the community at large. Without this kind of
support, the receptivity of the people to make use of even available
services cannot be ensured.
b) Adequate resources for making available Reproductive and Child Health
services to all rural and urban communities in the country.
c) Accountability of performance among the health workers and efficiency of
the health system. Without such efficiency the quality of services to
citizens or even effective access to health services cannot be ensured.
d) 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
before them and acquire capability / willingness to assess consequences of
their present actions for future. Therefore, the effort of the Department of
Family Welfare is to collaborate with the related departments and non
governmental organisations for seeking support of their programmes for
140
The main highlights of the RCH Programme are • ^'H8
reproductlve tract infection (RTI).
re8u,a,“”’
Sdis
b)’ The
b’ied'Tihe bS,idoefd &
'
and
parttcipatory planning.and the target free approach
c) The
various imerventioTSqua^tyofc^^he F^tVf
decentraIised
i^8 f°r providing
set up at sub-district level will provide comnreh"
UnitS (FRUs) bein8
newborn care. Similarly, RCH facilities in PHCs iX en?ergency obstetric and
d) The Programme will improve access of them
be substantiaI1y uPgraded.
commonly required. It is proposed to nrov-H™^-!7 t0 'T110115 services that are
«.„g and IUD insenS “Xd
™C3'
) lhe programme aims at improving the out rparh mf
vulnerable groups of population who have Z °f s"rvices Particularly for the
the planning process eg.,
substantially been left out of
‘ XdiSr,eS "" be taken
““ up
•riba! popuMo„
a rauch ta8er
■
•»
»d dev^pnaeX'BM Sb^ponedtl
and assessmei'rfStSwfe?plan“nS’ “"Pl™eatation
Programme Interventions:
V")
on differ approact Inputs in
on the capability of the health systei^in the JeC.aUSe e®cient delivery will depend
proposed to be strengthened and streamlined sne^ll Thefefore’ basic facilities are
otter districts already have such facilities anJth
Weaker districts as the
Proposed the relatively advanced d XtsX
S0Phis^ed facilities are
make use of them effective. All the diX^ J
the CaPabiW to
A (58), B (184) and C (265) on the basis of C T XCategOnsed mto categories
Rate which reasonably represent the RCH
Female Literacy
covered
„ phasei' nvonner
Th^«*.s w.l,
differentiated RCH interventions would be as below:
h300"3117
and
141
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Interventions in all districts
Child Survival interventions (as availble under CSSM Programme)
Safe Mother hood interventions (as
under CSSM Programme)
Facilitation for operationalisation of
Target Free Approach
Institutional Development
Interventions in selected States / Districts
• Screening and treatment of RTI / STI
Emergency Obstetric Care at selected
FRUs by providing drugs
• Essential Obstetric Care by providing
Drugs and PPN / Staff nurse at PHCs
• Additional ANM at sub-centres in the
selected districts for ensuring MCH care
• Improved delivery services and
emergency care by providing equipment
kits, IUD insertions and ANM kits at
sub-centres
• Rental to contracted PHUs / ANMs not
provided Government accommodation
• Facility of Referral transport for ' ’
pregnant women’s
•
Integrated training package
Modified Management Information
. System
IEC activities & counselling on health
sexuality and gender
Urban & Tribal Areas RCH package
District sub-projects under local
capacity enhancement
RTI / STI clinics at District Hospitals
(where not available)
Facility for safe abortions at PHCs by
providing equipments, contractual
doctors etc.,
Enhanced community participation
through panchayats, Women’s groups
and NGOs
Minor Civil Works
Provision for lab. technicians for
laboratory diagnosis of RTI/STI & EOC
Adolescent health and reproductive
hygiene
5. National T B Control Programme :
Tuberculosis is a major public health problem in India contributing 1/4^ of the global
burden. 12-14 million people are estimated to be suffering from active disease of which 33.5 million are highly infectious. As per the National Survey conducted during 1955-58, by
the Indian Council of Medical Research to find out the magnitude of the T.B. problem in the
country, it revealed that Tuberculosis is prevalent throughout length and breadth of country
equally in urban and rural areas. 2% of the population is suffering from pulmonary
Tuberculosis of which 0.4% are sputum positives.
The National T.B. Control Programme was evolved ini 962 on the findings of above
study in Karnataka the programme is in operation froml962.
Objectives :
To reduce the Tuberculosis in the community "'to that level when it ceases to be a
public health problem by :
142
i)
ii)
iii)
Detection of Tuberculosis cases attending the OPD and providing effective
treatment.
To reduce morbidity and mortality due to TB.
To break the chain of transmission in the community.
Implementation :
Tubercu^n^enfrim,3lemenlat^n °f
Ar rhe
i) District T B Centres
■ ii) Addl. Dist. T B Centres
iii) Microscopic Centres
iv) X-ray Centres
.
v) Referring Centres
State.
-27
-5
-805
- 172
-840
PrOgramme for the
given in^XTxmelppendel ?
1992-93 to 1997-98 is
6. National Leprosy Eradication Programme :
programme In 19X0
an’
ft
Was ma^e a centrally sponsored
ieN r,e :r°sy byCo,2000
as ',ro1“
Programme
was redesignated as Nationfl ZX| 5P . Na,,0“‘
-ategy based on
•he multidnjg ltopy
Strategy ;
^rE°P{
” ■Xpp“^1
rxxs:
The revised strategy is based on :
1.
2.
3.
Early detection of cases (by Population Survey, School
Surveys, Contact
Examination and Voluntary Referral).
Short term multidrug therapy.
Health Education and Rehabilitatio n activities.
.. .assss
The WHO r;
evidencies in districts
Belgaum Division, My
I
The infrastructure created under the programme me as follows :
143
State Level Programme Officer is the Joint Director (Leprosy)
1. S.L.O.
2. S.S.A. Units
3. D.L.O
4. L.C.U
5. S.E.T
6. U.L.C
7. T.H.W
8. R.S.U
9. L.R.P.U
10. M.L.C.U
11. M.L.T.U
12. V.O.L
- 1
-4
- 18
-31
-677
-49
-22
-6
-2+1
- 14
- 14
-25
The revised objective is to eliminate the Leprosy by 2000 AD to bring down the
prevalence of Leprosy to less than 1 per 10000 population by implementing the revised
strategy.
z -
The progress of the programme implementation is given in the Annexure appended.
7. National Programme for Control of Blindness (NPCB):
This programme was launched in 1976, incorporating the earlier Trachome 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 2000 AD and to provide comprehensive Eye Care through
Primary Health Care. The cataract cases constitute 55 % of the total blindness in the country.
These programme activities are mainly providing services by organising eye camps in the
rural areas for cataract cases. Mobile ophthalmic units are providing the services in the State.
All the districts are having these mobile ophthalmic units. Danida is providing assistance to
this programme. 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 (Ophthalmology) heads the State Ophthalmic Cell who is
responsible for implementation of programme in the State. This is a 100% centrally
sponsored programme.
8. Iodine Deficiency Disorders (IDD) Programme :
The Goitre Control Programme was started in 1962, based on iodized salt. In
Karnataka also the Districts of Chikkamagalur and Kodagu are affected more compared to
other districts.
The programme is implemented all over the State. Government has banned sale of
non-iodized salt.
r
9. National AIDS Control Programme :
It is new jprogramme and launched by Govt, of India with World Bank Assistance
being 100% centrally sponsored
.
I programme. The State AIDS Cell is responsible for
144
i
as
guidelines of NACO
been established during 2ay 1992Tha’Ams^”'"";, ffic%in ,he AIDS''11 »hich has
Bangalore in 1987
T11' AIDS Surveillance Centre was started at BMC
Components of the programme :
1) Programme Management - Store AIDS Cell
o
~ Empowered Committee
2) Surveillance and Clinical Management
) Blood Safety - Blood component separation facility
- Modernisation of Blood Banks
cm
~ Z°naI Blood Testing Centres
V SID Control Programme
5) Training Programme
6) IEC
7) NGO - coordination
Infrastructure:
In addition to State AIDS cell
0 Blood Banks approved for modernisation - 2
ii) Surveillance Centes - 3
jii) Sentinel sites - 4 ANC, 8 STD
iv) Zonal Blood Testing Centres - 10
v) STD Clinics Supproted -30
vi) Blood component separation facilities
-1
vn) NGO financially supported - 20
Non-financially supported -15
HIV infection and AIDS cases reported in Karnataka upto end of May ’98.
1. Total no. of samples screened for HIV
-388586
2. No. of HIV +ve confirmed
-3973
3. Zero positive rate
-10.22 per 1000 tested
4. No. of AIDS cases reported
-139
In Karnataka
-127
Diarrhoeal Disease Control Programme:
bring down the^momh J^e^o toh^aFrSed^d0186356^ Pr°gramme was started to
promotion of Oral Rehydration Theranv Thi.
d
(including chol^a) through
Plan to reduce the mortality due to diamhoeX
mtensified durin8 Seventh
integrated with Primary Health C^e a^^^
200°- ™s P^amme is
are supplied to subcentres and village-health X de a ‘u
SP'tal 1?VeL 0RS Packets
Education and Health Education materials tkle ‘L
t
impOrtant c'JmPonent is Health
regional language is supplied to PHCs for free distribufio'il°f Dian-hoea” in local /
145
STD Control Programme :
In 1949 the programme was started as a pilot project for control of venereal diseases.
In 1955, the planning commission recommended for establishment of one VD clinic in every
District Hospital and one Head quarter clinic and Laboratory in every state.
The programme was started in 1957 by setting up of a Central V D Organisation in
Directorate General of Health Services for implementing and co-ordination of programme in
the country. Injection Penicillin (PAM) and VDRL Antigen were supplied free to VD clinics.
The Govt, of India discontinued the free supply of drugs to States during 1981-82 and
strategy was focussed on training, teaching and research and various aspects of STD Training
Centres established are as follows :
1) Institute for study of V D Madras, Medical College.
2) STD Training and Demonstration Centre, Safdarjang Hospital, New Delhi and
other two centres for remaining areas are at Calcutta and 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 STD cases.
Guinea-Worm Eradication Programme ;
The Govt, of India launched the Guineaworm Eradication Programme in 1983-84
during Sixth Five Year plan after recongnising it as a public health problem. This is centrally
sponsored programme (50:50). In Independent Appraisal of the programme was made in
1985. As on January 1986, six states were endemic affecting 7114 villages, in 481 PHCs and
66 districts in the country. The Tamil Nadu State vigorously implemented the programme
before National Programme began and no indigenous cases since 1981.
Programme components /strategy:
Providing of drinking water sources on priority basis.
Vector control with application of Abate (Temophos) giving concentration of 1
mg per litre (IPPM)
j) Health Education including personal prophylaxis i.e., Boiling of drinking water,
sieving of unprotected water.
4) Supply of Nylon mesh filters.
5) Active Surveillance of cash twice yearly. -
1)
2)
This program is implemented by the Primary Health Care staff. The goal is to
eradicate the disease in all affected areas. The programme input was only one cell at
Directorate at CMD section to monitor the implementation and evaluate the activities. The
searches were carried out twice yearly usually in December and June every year. In
Karnataka the Districts of Gulbarga Division, Bijapur and Dharwad were affected. Due to
implementation of above programme there are no indigenous cases in these area since last
three years. Actions are taken for preparing the areas for WHO certification. The Award of
Rs. 100/- to the informer and Rs. 500/- for case for treatment purpose. The suspected
reported should be investigated reported by PHC Medical Officer and documented for the
verification team.
146
Minimum Needs Programme :
iiving
‘pe^ ^^eeri™:
““of p“pleComponents:
1) Rural 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 :
popuiatbn i“p^“72?0007o^ion
‘S 'hf"’<>ne PHC f°'
eZXto" ? ?‘TT “d M00 “
every 1 lakh population by the year 2000 AD.
3°“°
t0
Accordingly the State Government has
been establishing the subcentres, PHCs and
CHCs in the state.
National Diabetic Control Programme :
Objectives:
1) Identification of high risk subjects at an
early stage and imparting appropriate
health education.
2) Early diagnosis and management of cases
coZhcXSbeZ5 °f “““ me,i,b01iC ’S
car(ii°-vascular
The programme functions at three levels.
(1) Subcentre, (2) PHCs and (3) District Hospital
Govt. (of~ Karnataka has sanctioned this scheme to Hassan and Dakshina Kannad,
Districts. Training has been given t^"^
-al 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.
of Oncology to takeup the
Cancer
147
1) District Cancer Control Programme :
The District Cancer Control Programme is sanctioned to Dharwad and Chikkamagalur
Districts in the Eight Five Year Plan. The activities carried (1) 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 hand
1
1993-94
24542
2
1994-95
21067
3
1995096
18615
4
1996-97
17766
5
1997-98
12019
National Tuberculosis Control Programme
SI. No.
Year
Cases on hand
1
1993-94
67790
2
1994-95
76819
3
1995096
83244
4
1996-97
81785
5
1997-98
79984
148
RESPONSIBILITY OF DRAWING AND DISBURSING OFFICERS
K. MRUTHYUNJAYASWAMY
Faculty (Financial Management)
A.T.I., Mysore.
and
5. SIDDARAJE GOWDA
JOINT CONTROLLER (Retd),
State Accounts Department,
Mysore.
Duties towards Accounts :
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 pleas that he was
misled by his subordinates (Art. 3 of KFC)
Receipts :
1. Amount realised on behalf of government should be paid into government
treasury within 2 days since amounts collected should not be kept away form the
treasury balance (Art. 4&7)
2. Separate accounts should be maintained for government money and nongovernment money (Art .4)
Government dues paid in the form of cash, cheque, bank drafts, postal orders and
money orders should be accepted (Art.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 of behalf of government must give the
payer a receipt in KFC from No. 1. (Art.6)
6. Heads of offices should keep a complete account of the receipt books that they
have received (Art.6)
J
7. The money received should be brought to the cash book immediately the receiot
number bemg noted therein (Art.6)
’
8. Any person paying money into government treasury will present with it challan in
uphcate in KFC Form No. 2. When money is paid by a private party into a
freasury, the copies of the challan should be initialled by the departmental officer
^Art.oj
9. At places where the cash business of the treasuries is conducted by the bank
cheques on local banks may be accepted. When cheque is received, onlv a
^cleTred^Art 9)0WledSiPent
be iSSUed after the CheqUe
'' LopX
^"°"ld P™p,ly be pu"ched' °,he™ise “
11. The drawing and disbursing officers are required to write their cash books
independently and not on the basis of treasury schedule and send their monthly
149
accounts/returns to the controlling officers after duly reconciling 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 his 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.
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.
_1__ ._Z
-~
Date of;
despatch from the
AG‘’_s Office.
- Date of return by the department after Verification.
- Regarding the yearly accounts ending on March
20th of 2nd month following
10th of 3rd month following
Not
later than the end- of
1
----------------------- June
The controlling authority should send certificate of reconciliation to A.G. for every
month before the 15th of the3rd following month. This certificate should also be recorded in
the pay bill for each month, pertaining to the reconciliation of 3rd previous month (Art.j2)
12. Rents due from government servants occupying government buildings should be
recovered regularly by deduction from the salary or establishment bills of such
government servant as per the rates and charges intimated 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 departments 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. When there are no double locking arrangements for the 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 cashior. 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 officers should be deposited in sealed packets in the
Government Treasuries with which the offices transact (Act. 12,13)
15. Every office should maintain “Register to watch the movement of
Cash/Bills/Cheques” and obtain the signature of concerned officials (Art. 345 of
KFC).
150
Expenditure :
&
and it“ "" <*C,iVB °f ,he “S’**”
L IllotmernTh
°f expenditure’there should be competent sanction and budget
a g0Vernment servant must satisfy the cannons of financial propriety
Every government servant should exercise the same vigilance in respect of
r8e0SDee^fhiseXPendltUre
3 m3n °f Ordinary Pmdence would exercise in
respect or nis own money;
U) b^tn?01117 C°,mpetent sanction expenditure shall pass an order which will
be to his own advantage directly or indirectly
“i)
Sh0“M ”°‘ be “ f"Our of ‘ Pmicul“ P"s»” ”• ««ion of
n
i)
‘V) receS™ S“Cl' “ T A” e,°'’ Sh°“ld
V)
V1
°f
be ‘
<° “»
I? SanCti°nin8 aathority should not incur expenditure which at al later date
may proved to be beyond his power of sanction : and
ZlP°SSlble resu!ts?hould 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 underhand that ±eZ oTal
claims of government servants should be discharged with the least possible delay
becX due
has^
one year
^e date when it
necessary (Art.20).
P
'
conddonabon of delay is
3. Before, condoning the delay regarding the arrears
of payment, the Head of
Department should exercise the following checks.
(a) Claims should be got scrutinised by Chief Accounts Officer
(b) Verification should be done with original records.
(c) The claim should be established beyond doubt
(d) It should not result in wrong or double payment.
(e) Suistable register to be maintained to watch such sanctions (Art. 20)
4' XfsurmXOf„7T,!,ain,S',0 aVOid d0"ble 'Inpayments the drawing
th~
5
b=
time. Clamims preferred within Z
b/ 7 discharged at the earliest possible
m no“ preferred
00^thXte
151
07494
office or the controlling officer or the A.G as the case may be, within one year
from the date on which it becomes due (Art. 22-A)
7. The LTC/HTC bills should be submitted by concerned government servants
within one month, from the date on which it becomes due (Art. 22-A)
8. The Head of an Office may authorise a gazetted government servant serving under
him to sign bills, vouchers, and payment orders, for him. But the heads of the
office continue to be held responsible (Art.24).
9. The head of the office shall ensure that the payment is mad to actual payee only
and he should obtain clear acknowledgement (Art.24)
10. A government servant supplied with funds for expenditure shall be responsible for.
such funds untill an account of them has been rendered to the satisfaction of the
audit office. In cases in which the acquittances of the actual payees are not sent
for audit, the government servant supplied with funds shall be held personally
responsible for seeing that the payments are made to the person entitled to receive
them. He shall obtain for every disbursement which he makes on behalf of
government including every repayment of moneys which have been deposited
with the government a voucher setting forth full and clear particulars of the claim,
using as far as possible the particular form if any, prescribed for the purpose and
shall obtain at the time of making payment either on the voucher or on a separate
paper to be attached to it, an acknowledement of the payment signed by the payee
by hand and ink. Fof the amount equal to Rs.500 or exceeding Rs.500 stamped
acknowledgement should be obtained. In exceptional cases, if it is impossible to
obtain proper vouchers, the disbursing officer may record the certificate saying
that charges are reasonable and actually paid. Whe an article is obtained by VPP
the value payable cover shall be treated as voucher. Pay order should be recorded
on voucher in words and figures with attestation by disbursing officer. Without
this order, payment 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 untill he has paid them to the person who areentitled to receive them and
has obtrained their dated acknowledgements, duly stamped where necessary.
These acknowledgements shall be taken as a rule on the office copy of the bill.
Separtate acquittances may be maintained for staff and for private persons. The
copies of the bills sent to treasury to be maintained in the form of register
(Art.52).
&
12. .LA register to be maintained in KFC Form No. 10 to watch the undisbursed
amounts (Art. 52).
13. Sub-vouchers to contingent bills should be cancelled in such a manner that they
canno^subsequently be used fraudulently to claim or support a further payment
14. Every government servant should give proper attention to all objections and
orders received from the A.G. without any avoidable delay. A register shall be
152
maintained in each office in KFC Form No 11 for reconfirm
communicated by the Audit Office (Art.60).
8
Wh° draW biHs f0r pay
15'
k- ■
obJectlons
aUo^ances on contingent
bifi N d
Pr™ar’ 7 resP°nsible for
correctness of the amount for which each
will Ld
Lf any a,m0Unt IS drawn in excess of what is due, the drawing office^
will be required to make good the excess amount is drawn (Art.62)
t
it t
gave™. CsX“diXXeta Jhey
rtf'
18' PWDUJbFOkSrenUired by disbursing Officers authorised to draw on treasuries like
PWD & Forest Departments, etc., should be obtained by them from thXL
o icer on a requisition signed by the disbursin'? officer himself Chen k
than the amount written on cheque. All cheaues/drafN on hnnVe f
ZftT in each
^payment of sat
addition of the wf'taomt 'St
‘nV“ably be crossedhanding it over to ti naX X t 0”ly ' 'f Che<IUe lira'™ is
treasury Furthe the
f u
P
tore
t0 be °btained from ba^ and /o
73. Aff
tb
F“ N"
19. No government servants may open an account with
oi moneys by him in his official capacity (Art.76). a private bank for the deposit
“ wtchVayLdtc[.o°„°etTheee^tPOhrai7hPOS,S bey<’nd ‘he peri°d *
accorded sanction, the holders of such te^
comPetont authority has not
tXTtf,y 111 atir 71 ”^P“i
period up to which the ft f
f (t8“
’L ofa teXitSsef' taS tetout'X’t
e-. . ease of if
b' ‘ta™ f°r the day
«
payment to the claimant upto Rs.5000 without insisting for legal authority, If it
exceeds Rs 5000, office head has to obtain an indemnity bond in KFC ?orm
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 of income tax at the prescribed
rates in respect of non-gazetted staff (Art. 8 8)
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 therepresentation 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 be shown as a deduction in the
Pay Bill. In respect of Society dues it may be disbursed in cash;
(c) .The Officer should not enter into correspondence with the Court or
forward representations. He has to simply execute provided the money is
available;
(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 of pay:
(i)
Salary to the extent of first four hundred rupees and two-thirds the
remainder is not liable for attachment towards the execution of
pay decree, other than a decree for maintenance.
(ii)
All kinds of Travelling Allowances, Conveyance Allowances,
Uniform and Ration Allowances, House Rent Allowances,
Reimbursement of Medical Allowances and Allowances granted
to provide relief against increased cost of living are exempted
from attachment.
24. Out of subsistence allowance, taxes, house rent loans and advances are
. compulsory deductions. If government servant who under suspension, requests,
insurance premium,dues of cooperative societies, recovery of GPE advance may
be deducted. The GPF subscriptions, court attachments and recovery of loss
should not be made. The rate of recovery out of subsistence allowance should not
exceed one-third of the gross subsistence allowance (Art.94-A).
25. In case where an officer deputed for training does not discharge statutory duties
and the handing over of cash or stores if not involved and the total absence from
headquarters does not exceed 10 days, the handing over and taking over charge of
the post is not required.
26. Every transfer of charge of a gazetted government servant proceeding on leave
should, without fail be reported by post on the same day to the A.G. in Form
154
No. 19. Every government servant who is resnonsible for
.
advances and who is transferred to another office before M v 1
< T' °f
amounts outstanding against him should leave for the informafior and
H
within the time allowed bv the"snnef
"
u JUSting the outstanding amounts
responsibility wih not cease td J .
8
If he d°eS not do s°> his
respect of the items not brought to he iT’
he‘d resPonsible in
advances and un remedied objections should bTg^ven by^he^elie
rehevmg government servant in KFC From No. 20 &21 respectively U'lOO).
27'
z*.vx.arsfcr b"n "ad=-
after the dose of the month, attaching Ze te theiZ™LPcSl‘S
ZZeTdZvlZZXZeT.
retUm journey shaI1 be
borne by local body concerned (Art. 129).
o“h7Z‘reZZ
SnZZ^^^
siz X“z:cxfc1Er4e“
government servant shall be prepared bv the / °'
allowances of a
(Art. 132).
P P
y the drawing and disbursing officers
29' T/aye'ling allowance °f establishment other than p•
- permanent or fixed allowances
'umeys and
i one
government servw The
™S °f 3 Partlcular month
respectof a
--------ininrespect
a-1_
1
z*
bills ™ Z JZeHnZcVeZ ““““W
ailowanei
he countersZZ m
WhiCh he
™“ "note
0,e “the
“ biUs
which
he will
bills
30' cZZble Vto “““KFC fZn? “
balances. In the case of
Z.?0™8 the receiI>K' issues and
KFC Form No 34-A md a ZoZZ
’ Day Book in
kind of article are suffcL, Z
8 aCC°,m,
Fo™
« for each
For books and periodicals senaraf0
8Ter’tbese reSisters should be verified,
-s ‘X
zzc zzrxr
‘"o KFC
N<X 35 « be
ZZhe“eOff,
“ ”Fon
0M "°ffe
attached to the April pavt il Xead cm?for the first pay bin ofrdieving
155
Microwaving : The process incorporates shredding. Steam, spraying and microwave
irradiation.
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.
External Transportation :
It is the transportation that carries infectious-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, uni versa precautions, ‘personal
pretective equipment, etc.
Project Support:
•
•
•
State level
District level
Facility level
<
160
1
health management information system
_________________ Sri G- Prakasham‘ Join‘ Director, Demography, DH&FWS
The MIS varies according
<
to the structure of the system and has to.cater to the
organisational needs of a) Research b) Pl,
and e) Implementation and maintenance. arming c) Policy formulation d) System integration
Ml foe MoX
COnC'P‘ ”d ’ “nflU‘“e °f
S"b
* 1- fo
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
o) Planning and Evaluation
7) Projections (Eg:Population)
3. Date /Information is the life blood of Management and is essential at all levels of
the organisation
a) For reporting to the next higher authorities and
b) For momtoring and review. It results in action and corrective
1C V Clo.
measures at all
&
(coordba.ion
(N»L Agency for
S“^ Hentt^ p''’10?1 ^.f1* P'"31iC Heal“' -- CB™
(Nodal Agency for HMIS)
Education!-SRHi n
u- oat£ Hea th & Family Welfare Departments (+ Medical
) SBHI - Demographic & Evaluation Cell (FW & MCH) or (RCH)
5. Rural Health set up
-SC-PHC-CHC
1“" “d Heea“h Cm iS
only-ee™
2SS1150
7. Health Programmes
a) RCH (FW+CSSM+STI/RTI)
b) Malaria Eradication
c) Tuberculosis
d) Leprocy Eradication , *
e) Control of Blindness
f) AIDS
g) Nutrition
h) Communicable Diseases
161
public enterprises
8. NIC : This is a nation wide, satellite-based Computer Communication Network
(NICNET) encompassing all districts, State Capitals and the centre, facilitating District
information System (DISNIC)at district level and essential data base for States and the
Central Government Departments.
9. Registers to be maintained at PHC level
1.
2.
3.
4.
5.
6.
7.
8.
9
10.
11.
12.
13.
Sub-centre Register-1
Sub-centre Register-2
Sub-centre Register-3
Sub-centre Register-4
Sub-centre Register-5
Sub-centre Register-6
Sub-centre Register-7
Sub-centre Register-8
Sub-centre Register-9
Sub-centre Register-10
Sub-centre Register-11
Sub-centre Register-12
Sub-centre Register-13
Sub-cnetre and Village Information
Household Information
Eligible Couple & Children Information
Family Welfare Services
Maternal Care Serivces
Child Care &Information Services
Tuberculosis &Leprosy Control
Malaria Blood Smear &Treatment
Home visit Diary
Clinic Register
Stock & Issue Register
Vital events-Births
Vital events-Deaths
10. Reports to be sent by the PHC
Family Welfare :
1) KDP Report
2) Form-14 (Now replaced by 7)
3) OP & CC,IUD Reports
4) Stock postion of OP,CC,IUD
5) Quarterly reports -(Socio Demographic Data)
6) Sterilisation death (Quarterly)
7) Conception after Sterilisation (Quarterly)
8) MTP (Monthly)
9) Eligible Couple Analysis
10) Age wise and Children wise Sterilisation Reports (only for sterilisation)
Immunisation (UIP) :
1) CSSM reports (Monsthly)-Pneumonis, ORT episodes, Diarhhoreal diseases
2) MCH repoets -1) Special report (Deliveries, IFA Tablets) Monthly
2) Infant & Maternal deaths
3) School Helath
4) Dias Training
3) Leprosy- 1) Survey reports (Monthly)
2) KDP report
3) Form LI, E2, and L3
4) Malaria- Passive and Active Reports (Monthly)
MF 1-14
Lab report (Weekly/Monthly)
162
i
5) TB - Sputum collection and case detection
Stock Position of drugs
NPCB :
Cataract Operation, Survey Report (MLY) Total Operation and Refractions
Nutrition :
I1 Xsec,ored advisore
-
•3) Vitamin- ‘A’ report
4) NED (Nutrition, Education and Demonstration)
MEM (IED reports):
1) Mahila Arogya Sanghas
2) Exhibitions
3) Film Shows
4) Folk media
CMD (MLY) :
Indoor and outdoor patients
JE & GE Cases
Dengue fever, Sanake Bite, Dog Bite
Morbidity and Mortality report
RCH (Reproductive and Child Health services):
AssessrantAnn™ if7FTT’
approach t0 Family Welfare is Community Needs
rZ
fOrmatS have been prescribed- AccldingTyS
services/activities as also thestocklositlono/d™ N°’2’m°nthIy
on various
No.7.
k P°SltlOn Of druSs vaccmes etc., is to be reported in Form
163
8. NIC : This is a nation wide, satellite-based Computer Communication Network
(NICNET) encompassing all districts, State Capitals and the centre, facilitating District
information System (DISNIC)at district level and essential data base for States and the
Central Government Departments.
9. Registers to be maintained at PHC level
1.
2.
3.
4.
5.
6.
7.
8.
9
10.
11.
12.
13.
Sub-centre Register-1
Sub-centre Register -2
Sub-centre Register-3
Sub-centre Register-4
Sub-centre Register-5
Sub-centre Register-6
Sub-centre Register-7
Sub-centre Register-8
Sub-centre Register-9
Sub-centre Register-10
Sub-centre Register-11
Sub-centre Register-12
Sub-centre Register-13
Sub-cnetre and Village Information
Household Information
Eligible Couple & Children Information
Family Welfare Services
Maternal Care Serivces
Child Care &Information Services
Tuberculosis &Leprosy Control
Malaria Blood Smear &Treatment
Home visit Diary
Clinic Register
Stock & Issue Register
Vital events-Births
Vital events-Deaths
10. Reports to be sent by the PHC
Family Welfare :
1) KDP Report
2) Form-14 (Now replaced by 7)
3) OP & CC,IUD Reports
4) Stock postion of OP,CC,IUD
5) Quarterly reports -{Socio Demographic Data)
6) Sterilisation death (Quarterly)
7) Conception after Sterilisation (Quarterly)
8) MTP (Monthly)
9) Eligible Couple Analysis
10) Age wise and Children wise Sterilisation Reports (only for sterilisation)
Immunisation (DIP):
1) CSSM reports (Monsthly)-Pneumonis, ORT episodes, Diarhhoreal diseases
2) MCH repoets -1) Special report (Deliveries, IFA Tablets) Monthly
2) Infant & Maternal deaths
3) School Helath
4) Dias Training
3) Leprosy- 1) Survey reports (Monthly)
2) KDP report,
3) Form LI, E2, and L3
4) Malaria- Passive and Active Reports (Monthly)
MF 1-14
Lab report (Weekly/Monthly)
162
5) TB - Sputum collection and case detection
Stock Position of drugs
NPCB :
Cataract Operation, Survey Report (MLY) Total Operation and Refractions
Nutrition :
21 wr S r!p°rt.(Monthly)Pr°Ject advisors report and sectored advisore report
2) Iodine defeciency-Goitre control programme.
P
3) Vitamin- ‘A’ report
4) NED (Nutrition, Education and Demonstration)
MEM (IED reports) :
1) Mahila Arogya Sanghas
2) Exhibitions
3) Film Shows
4) Folk media
CMD (MLY) :
Indoor and outdoor patients
JE & GE Cases
Dengue fever, Sanake Bite, Dog Bite
Morbidity and Mortality report
RCH (Reproductive and Child Health services):
services/ac.ivities as also Vstoek^nV^s
163
beZo'X’ta
MANAGEMENT - CONCEPTS, PRINCIPLES, FUNCTIONS,
APPLICATIONS IN HEALTH MANAGEMENT
Dr. Kishore Murthy
Definition of Management:
Management is a distinct process consisting of activities of Planning, Actuating and
Controlling performed to determine and accomplish stated objectives with the use of human
beings and other resources.
Popularly Getting things done through other people.”
Six M’s of Management of “basic resources” are subjected to the fundamental
functions of management.
Basic Resources
Fundamental Functions
Stated
The Process of Mgt.
End Results
Objectives
The 6 M’s
Men
Materials
Planning
Actuating
Organising
Controlling
Machines
Methods
Money
Markets
INPUTS
>
PROCESS
>
OUTPUT
Management is getting the right things done in right way in i
right time by right
persons with right amount of resources and with effective use of resources.
Why do you need Management ?
•
•
Human efforts more productive
SBociX better equipment’ pIants> offices’ Products and services and human relations to
Improvements and progress are.the constant watchwords.
Brings order to endeavors by combining isolated events and disjointed information
into meaningful relationships.
formation
Accomplishment of many social , economic and political goals of any country.
164
Management: Is it Art or Science ?
- -enee
combine^ XaS^
“dn”
P
K
the proper rXces’’ ”
performance. Science teaches one to “know” art teaches one
d°
'ffiCien“y “d rffec,iv'ly b' ““'ssfirl with
Technical, Human and Conceptual Requirements :
““ COn“I’t"al
■echmcXwTow™'
« ta>
Lower jobs require more technical and human needs with less emphasis on conceptual
work.
Organisation
Levels
Top
Conceptual
Middle
Supervisory
Human
Technical
Knowledge & Skill required
Key characteristics to understanding Mianagement:
1. Management is purposeful and Management makes things happen.
2. Management is an activity, not just a person or group of persons.
3.
M.n?ement 1S accomPllshed bx
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?
Actuating
T"—
Who is to do what?
With what’
Relationships, What authority, Under
what Physical environment?
Controlling
Getting the Employees to Want to Work
Follow upjp see that planned work is
willingly with good co-operation
being properly carried out and if not to
apply remedial measures.
165
MANAGEMENT IS DYNAMIC, NOT STATIC
Important activities of each fundamental function of management
Planning
Organising
amplify
Clarify,
and
determine Breakdown works into operative duties.
objectives
Group operative duties into operative
Forecast
positions.
Assemble
Establish
the
conditions
operative
into
positions
and manageable and related units.
assumptions under with the work will be Clarify position requirements.
done
Select and state tasks to accomplish Select and place individual on proper
objectives
job.
Establish
an
overall
of Utilise and agree upon proper authority
plan
accomplishment, emphasizing creativity for each management member.
to find new and better means for
accomplishing the work.
Provide personnel facilities and other
Establish policies, procedures, standards resources.
and methods of accomplishment.
Adjust the organization in light of
Anticipate possible future problems.
control results.
Vlodify plans in light of control results.
Actuating
Controlling
Practice participation by all affected by Compare results with plans in general.
the decision of act.
Appraise results against performance
> A y
Lead and challenge others to do their standards.
best
Device effective media for measuring
Motivate members
operations.
Communicate effectively
Make known the measuring media
Develop
potentials
members
to
realize
full Transfer
detailed
data
into
form
showing comparisons and variances.
Reward by recognition and pay for work Suggest conective actions, if needed.
well done.
Inform
responsible
members
Satisfy needs of employees through their interpretations.
166
of
work efforts.
Ad-iust controlling in light
Revise actuation efforts in light of
results.
control of results.
£
A
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.
conductpewdic and annual appraisal 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:
For e.g.,
oF^lXSX'healT01’1^6
predetermined g°alsOfficer has to plan various tasks dMdeSe Xv
?• pr°§rammes’ 1116 pHC Medical
supervision so that the ultimate objective or taraPhlS
pr°vide support and
acts as a manager in order to get thiigs done through'w^'X.
M°H
t
A medical officer at PHC is both a
to differentiate between these two roles, : technical person and a manager. One must be able
As a technical worker the medical officer is doing
some of the following:
1. Diagnosis and treatment.
2. Prescribing
167
3.
4.
5.
6.
Follow-up treatment.
Any other form of treatment
Preventive and promotive services
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
3. Maintaining adequate supplies and equipment
4. Supervising information gathering and recording
5. Managing the PHC vehicles
6. Solving problems
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 frustrated with this feeling that they
develop a negative towards administrative and managerial functions. Other medical officers
ten 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
performance a great deal through appropriate management and thus provide better health care
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. n 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.
3. 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.
Functions of the MOH :
Any organisation is like a pyramid, and at the vertex is the Chief Executive or MOH
which sUndTaTf^r ftinCtionS are summed UP by Lut^r Gulick in the word ‘POSDCORB’’
168
Planning
Plan the work that needs to be done and the method, how it should be
Organising
...
Staffing
■' ■
Directing
Coordinationg...
Reporting
Budgeting
Giving
the plan
Giving the
plan some
some shape
shape and
and establish
establish the
the fotmal
formal structme of
authority through which work sub-divisions are arranged
Ivn Whmle Per!Onnel ^CtiOnS Of bringing’ training
maintaining
favourable conditions of work.
®
The continuous task of making decision and giving instructions
The all-important duty of interrelating the various parts of the work
Keeping those to whom the executive is responsible infotmed about
^d inspectioT
infOimed thr0Ugh reCOrd retums
With all that goes with budgeting in the form
of fiscal planning.
accounting and control.
Planning:
rc8ardins
Advantages of Planning:
1. Makes for purposeful and orderly activities.
2. Points out need for future changes.
3. Answers “what if’ question.
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.
Types of Planning:
1. Strategic planning (Long Term Planning)
2. Tactical Planning (Methodology Planning)
Strategic Planning :
1. Answers
2. Defines
3. Analysis
4. Determines
5. Selects
6. Documents
Where should we be going.
Enterprise purpose served and its preferences.
Environmental factors influencing the operations,
constraints and opportunities revealed.
Real abilities of enterprise management, ability,
finance.
Strategic objectives.
Strategy.
169
Tactical Planning:
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 die 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 acquisitions, 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 Threats.
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.
Steps for Strategic Planning :
I.
Conduct SWOT (Strengths, Weaknesses, Opportunities and Threats) Analysis
a. Analyse the external environment
b. Analyse the internal environment
IL
Set objectives in terms of services to be provided, client segments, coverage
and 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 and activities can be planned to
meet the objectives.
170
7
•4
Overall view of planning and its relationship to the management process
Planning
A systematic through process
r
Strategic
Planning
Tactical
Planning
Purpose of enterprise
Technological,
sociological and
governmental
influences
Characteristics of
market
Demand for nroduct
Sales Forecast
Number and type of
customers
Establish who is
responsible for what
Allocate resources
Set measurements for ;
I each task
J
Policies or plans
giving guides and
restrains to the
L
Creativity:
> New ideas and
relationship
Particular plan
r»1annir»rr
WHAT action must be taken?
WHY must this action be taken?
WHERE shall the action take
place?
WHEN shall the action be taken?
Analyse
alternative
actions
Revision of the
particular plan
________
Re-evaluation of short-run,
intermediate, and long-run objectives
Subsequent
information and
Organise
>
Actuate
Control
171
Health Planning may be defined as deciding how the future pattern of health activities
would differ from the present, identifying the changes necessary to be accomplished and
specifying how those changes should be brought 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 cares.
Example of Faulty Planning :
In the corridor of a District Headquarter, an unopened crate was lying for more then 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-utilisation of the ILR which was badly
needed.
J
Such examples of failures of planning abound. Planning improves performance by:
1. Matching services to people’s needs.
2. Efficiently utilizing resources and
3. Coordinating activities to achieve desired results.
But for planning to be effective in improving performance, it should:
a) Identify key result areas and prioritize activities,
b) Provide sufficient flexibility to respond to local variations,
c) Be realistic and feasible,
d) Enable implementers to implement the plan by providing necessary resources, and
e) Motivate implementers sufficiently to carry out the plan.
172
The Planning Process in Health :
The essentials of
an effective planning in heath lie in
questions:
answering the following key
1 • Where are we no
2. Where are we want to reach
3. How well we get there
4.
5.
(Situational Analysis)
(Goals, objectives, priorities, targets
and
strategic decisions)
(Organisational constraint,
resources and
organisational
structure,
functions
and
•nd
conducting baseline surveys.
2. Establish health priorities of the area
3. oSes'7
g
Po?Wems’ heal,h "sources
through available sources'and
4. Setting targets for action.
5. Identify tasks to be performed
6.
key
7.
8. . evelop a momtormg plan and built in feedback
9.
objecrives and program
h ■
tasms'
Determine
10. Re-planning.
I. Health Situation Analysis:
“ ’^0W wllat cont"butes to ill health what
to be at risk, and’XtK™”
health care
could be
be underst
understood through'moZTpX-'
care resources
resources could
health “n<i
A.
i.
ii.
Hi.
iv.
v.
vi.
w>CbS °Se?ople mo"prone 10 be atrisk?
Wnat is the prevalence of various
maintaining health or causing m heaW?^ attItUdeS of the community help in
vii.
viii.
ix.
x.
How are land holdings?
Whm is the health status df the community at present?
173
B.
i.
Who provides health care to the community?
Which services are lacking in the area?
What types of health practitioners are available in the community?
How can appropriate services be developed to deal with health problems?
To
what extent the health services being provided are covering the population‘s
What is the degree of satisfaction with and the extent of utilization of the
neaith services provided in the community?
What community resources are available and which
can be utilized for
promoting health in the community?
ii.
iii.
iv.
v.
vi.
2. Establish Health Priorities:
order ofXXXXX ’X.0"' “'“s '°
0
health education
h“'th
“
b‘ COnm’11'‘i
““
ii) The diseases which are largely prevalent in weaker sections of the communisfv '
iii) It rist
P
With
tHe VulnerabIe grouPs of ^e society are largely
iv) The problems which can be tackled through community health action.
1 ne problems which are acute in nature.
vi) The chronic health problems in the area.
V)
3. Identification of Key Tasks:
acessibilit^^ ^6rVICe functI0ns based on priority problems determine the tasks and the
the nature of the tasslTand the
1^^^,ie yProach to the health care also determines
problems wouM
-
-
health
°f
“
Health promotion
Preventive action on causes
Early intervention to prevent the problems becoming acute or serious
Cure combined with referrals, and
Rehabilitation.
h:allh T
«■
—si
different activities reiated to a task at 'various leXLXve”dSe"„t toT''"''''' b“'
174
Planning Tasks:
The following table presents Planni
inning Tasks at Different Levels of Management:
Level ot Management
Top
Middle
Planning for
Strategic
Outcome
Operational
Input-output
Operating
Operational Activities
_-Planning Tasks
’developing strategies
-Negotiating goals
-^Allocating resources
-Planning for service delivery
-Negotinating targers
-Logistics support
-Mass communication
-Coordination
with
other
development departments
Encouragingcommunity
participation
-Home visits
-Follow-up
-Field Worker activities
-Supervision
-Clinic/Health
Centre
Operations
-Record keeping
SWOT Analysis:
how the organisation CM^nfluenc^T^viromem ^fo ofo^ T °.rgailisation 35 weJ1 as
(or threats) and the opportunities thrm.ah cZ "L- other words, identify the constraints
external environ™,..
““T8 °f ““
The
economic influences.
number of social, political, technological and
environment, one must turn inward to see how the
We!knesses’ aft« scanning the
its objectives with present strategy and whethtTnSm^
°f meetinS
involve not only appraising the objectives but a so t h th Change strategy- This should
as administration, education, services mLagemen n f ther °fgaxfati°nal Unctions such
general management.
’ 3113861116111 of financial and human resources and
ilfitate E&Jse
Opportunity 2d
Weakness>
ose are described below for a Health Care
Oramsation:
I Opportunities :
a.
facilities.
“
“ NGOs
,0 tl“care
“services
■>
He commm1ty4aowards
health
and
Hl- Involves of suppon manpower as poteri ,al
175
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.
xi. In community, growing acceptance of modem system of medicine.
II Threats :
i. Rate of population 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 part of different political parties to population control
measures.
vi. Lack of professionals commitment to the concept of primary health care.
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.
Ill Strength:
i.) Clearly defined programme policy, objectives and targets.
h ) 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
vi) Undue thrust to selected few programmes only
vii) Too much target completion orientation
vni) Lack of involvement of the functionaries in the decision making process
xi) Inadequate supervisory practices.
Common problem areas for Managers:
1. Decision making
2. Costs
3. r
Employee
recruitment/selction/training
4. Finances
5. JManagement
'
Information systems
6. Inventory Records
7. rSupervision, morale, motivation
8. Quality controls
“ S°‘V'
tad—
176
A. Planning:
1. Objectives of individuals
2. Objectives of the enterprise
3. Policies
--- J covering authority, prices, attitude toward competition
4. Internal
Procedures
pro^TfiC “ of ““"S PaPer
5.
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 evaluation employees.
3. Fulfilling personal needs through work satisfaction
4. Job enrichment and enlargement
6. Supervising
D. Controlling:
1. Establishing standards of performance
2. Measruing 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-achievment of targets for all programmes.
2. Insufficient and irregular supplies including drugs
3. Lack of properly trained health personnel
4. ^^culty in supervising peripheral areas due to terrain on
lack of transport
5. aggmg behind the implementation schedule.
* "Problem Analysis :
lay hXo IXX qX” 4W2^ 'V," Pr°CeSS
by step method for problem ana”sis
Indient
Hyposthesis
Data
7 heIp
The situation / Happening
The problem area
The information, facts arid
figures
177
Opting a step
-what is or is not?
Define and set limits /:
boundaries
Calculation and
analysis of relevant
date.
Qualification
Tangible and intangible factors
Expectations
Options
Objectives/Results________
Alternative Courses of action
Choice
Selectin of appropriate choice
Risk
Evaluation/Anticipation
Accord
Acceptance by affected group
Action
Implementation
Monitor
Follow through
Measurement: Values
and WeightagesAbsolute or Relative
-Musts and Wants
-Identification and
Search_____
-Desired
result/satisfaction
-Expected benefits and
costs and adverse future
effects_________
Individual vs. group
interation_____
Responsibility and
Accountability
delineation / assigning
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:
Workers are not going for required home visits
Health
------- 1 workers (female) do not stay at S.C. beyond their duty hours
->0% of the villages do not have trained dais.
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.
2.
3.
4.
Asad'
‘ he^ih Qfficcr your
___ problem is to increase the coverage of safe deliveries
distact
by trained personnel and utilise the hospital and CHC for referral of 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
in mch
MCH with
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.
178
d) Organising IEC activities to inform the community about the
personnel and advantage of getting deliveries conducted by training personnel5’
e) Ensure the availbility of Health Worker (F) and their supers ft Ework
g
P ace by making them to stay there beyond working hours.
p tren8theninSthe system of preventive ante natal visits at home
Emkphasizmg on the concurrent visits by the health supervisors (Female')
iXScVoffiS Wi,h J“°iOr SpeCia"S,S in Ol"i,■ A”d
” ••
a
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.
179
MANAGERIAL PROBLEMS IN THE DELIVERY OF HEALTH SERVICES
1 Problems Faced By Medical Officers
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-AVAILABILITY OF MEDICINES
INADEQUATEFOLLOW-UP OF PATIENTS
1.2
ORGANISING
1.2.2 SHORTAGE OF EQUIPMENTS
1.2.3 LACK OF PHYSICAL FACILITIES
1.2.4 INADEQUATE DELEGATION OF POWER
1.3
STAFFING
1.3.1 SHORTAGE OF DOCTORS
1.3.2 SHORTAGE OF PEONS
1.3.3 LACK OF TRAINING
1.3.4 UNATTACTIVE TERMS AND CONDITIONS
1.3.5 LACK COORPROMOTIONAL AVENUES
1.3.6 INADEQUATEFRINGE BENEFITS
1.4
DIRECTION
1.4.1 REFUSAL OF DOCTORS TO TAKE RESPONSIBILITY
1.4.2 INTERFERENCE OF CALLS III & IV UNION
1.4.3 NONINVOLVEMENTIN TRANSFER OF STAFF
1.5
COORDINATING
1.5.1 LACK OF COORDINATION BETWEEN VARIOUS SEGMENTS
1.5.2 ATITTUDE OF IPS
1.6
REPORTING
1.6.1 UNTRAINED STAFF
1.6.2 MORE CLERICAL WORK FOR DOCTORS
1.6.3 DUPLICATING OF WORK
J.7
BUDGETING
1.7.1 NON-INVOL VEMENT
1.7.2 INSUFFICIENT IMPREST MONEY
1.7.3 INADEQUATE FINANCIAL POWERS
1.8
PROBLEMS IN RELATION
PROFESSIONAL SKILL
OF
ADEQUATE
2. PROBLUMS FACED BY PARAMEDICAL STAFF
2.1
2.2
2.3
2.4
LHVS/ANMS/DAIS
PHARMACISTS
LABORATORY TECHNICIANS
DRESSERS
180
| ~-
UTILISATION
OF
3.
PROBLEMS FACED BY ADMINISTRATORS
3.1
INSUFFICIENT DELEGATION OF AUTHORITY
3.2
INADEQUATE ADMINISTRATIVE SET-UP
3.3
NON-AVAILBILITY OF STAFF
3.4
ALLOCATION OF DISPENSARY TO IPS
3.5
PROCUREMENT OF MEDICINES
3.6
PILFERAGE OF MEDICINES
3.7
LAX- CERTIFICATION
3.8
FINANCE
3.9
NON-AVAILABILITY OF LAND
4.
PROBLEMS FACED BY PATIENTS
4.1
LOCATION
4.2
WORKING HOURS OF STORE
4.3
LONG WAITING TIME
4.4
AMENITIES
4.5
ARRANGEMENTS FOR EXAMINATION IN PRIVACY
4.6
TIME DEVOTED BY DOCTORS
4.7
ATTITUDE AND BEHAVIOUR OF DOCTORS
4.8
AVAILABILITY OF MEDICINES
4.9
DOMICILIARY VISITS
4.10 REIMBURSEMENT FACILITY
4.11 REDRESSAL OF GRIEVANCES
5.
REFERRAL
5.2
5.3
5.4
5.5
5.6
5.7
5.8
5.9
INADEQUATE AMBULANCE SERVICE
WORKING HOURS OF O.P.D
OVER CROWDING
ATTITUDE AND BEHAVIOUR OF DOCTORS / STAFF
WAITING TIME
TIME DEVOTED BY DOCTOR
PROCEDURE OF ISSUE OF MEDICINES
ADMISSION IN HOSPITAL
181
DEPARTMENTAL ENQUIRIES
K.R. Srinivas. CAO, KHSDP
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. (C.C.A.) Rules is
satisfied prima facie that a Government Servant has misconducted or acted in a way
unbecoming of a Government Servant or has shown dereliction in discharge of Government
duties, etc., the Authority can initiate enquiry against Government Servant.
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
Government that a Government Servant has committed irregularities in discharge of his
duties as Government Servant, before enquiry is ordered under K.C.S. (C.C.A.) rules, the
concerned officer or Authority may appoint an officer to investigate into the veracity of the
a egations. While conducting investigation, the officer can examine any witness, inspect any
site or place and verify any record in order to know the correct position.
Then the Investigating Officer will submit a report to the officer who has ordered
investigation. Based on the report of the Investigating Officer, the Disciplinary Authority or
the Government as the case may be will decide whether enquiry under K.C.S. (C.C.A.) Rules
if ti,
1S T necessar?’that a departmental enquiry is always preceded by an Investigation.
It the Disciplinary Authority or the Appointing Authority is satisfied that prima facie a case
exists against Government Servant, it can proceed against Government Servant under K C S
(C.C.A.) Rules.
’ ' ‘
Either on the basis of Investigation Report or on the basis of available evidence
charges will have to be framed against a Government Servant either under Rule 11 or 12 of
he Rules. If two or more officers are involved, a joint enquiry is ordered under Rule 13 of the
“ “e fharSes
Proved after ^qtiiry, one of the penalties as prescribed under Rule 8
ill have to be imposed. If on enquiry charges are not proved, the Government Servant will
be exonerated of charges.
Sometimes Government Servant against whom the enquiry is contemplated will be
placed under Suspensi
nsion as provided under Rule 10 of the Rules. A suspension under Rule 10
is not X;£™t
;
’ 'hme?tYA GovemmerK, Servant is placed under suspension, when the
7~rities
car t0
es aPP
?pear
to be senous
serious and if
!f me
the Government feels that his continuance in the post
mvestigation efc- during the period of suspension, a subsistence
allowance is paid to Government Servant.
t;mp
Government Servant who is placed under suspension could be reinstated at anv
time either before completion of enquiry proceedings or after completion at the discretion of
182
as'on duiv
If ^7
nOt pr°Ved’the period Suspension will be treated
y. f the charges are proved and a penalty is imposed, the period of susnencinn will
not be regularised. However at the discretion of Disciplinary Authority the nerind
u
adjusted against any leave at the credit of Government SeZ{
be
Based on preliminary enquiry (Investigation Report) or on the basis of avaiUbu
evidence, the Disciplinary Authority will frame articles of charges against the Acc Sd
Government Servant (AGO/DGO) either under Rule 11 or 12 as the case may be
If in the opinion of Disciplinary Authority, the irregularities committed are
o”yy onlTfSo^r
7 Un<i" R,“‘e 12 I'1”’ RUl‘S' ‘f“q“iry iS Ordered “”d«
he following minor penalties can be imposed against the A.G.O
1. fine (for Group 4D’ 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.
ones,
- sedous
Disciplmaiy Authunty may impose any of the following major penalties tLeSTs’ '
(v) reduction to a lower time scale of pay, grade, post or service
(vi) compulsory retirement
(vii) removal from service
(viii) dismissal from service
Even when an enquiry is ordered under Rule 11, the Disciolinarv AnthnrtH,
can
impose any of the minor penalties also. But whenever an e^quiryis 1 ’
taken
up
under
Rule
12,
no major penalty can be imposed on the A.G.O.
The procedure involved in conducting an enquiry against AGO
tn bn fnii
j
scrupulously otherwise enquiry proceedings ^11 vitiate.
A.G.O. ,s to be followed
-
listed
of misconduct, list of documents
should be given a reasonable ZT 1 J '
t0 be SerVed °n the A-G OA.G.O.
and to state Whether he desires to beheid.11^11011 SUbmit
Statement °f his defence
On receipt of this statement, the Disciplinary Authority i
may conduct enquiry himself
---i are not
uy me /vlj.u. it all articles of charges are <admitted
’, ’.
by the A.G.O. then there is no
rsuZf
183
need to conduct enquiry any further. The Disciplinary Authority or the authority competent to
impose penalties under the Rules can impose any of the penalties as the case may be.
If the A.G.O. fails to give written statement in his defence, then also Disciplinary
Authority may inquire into the charges or appoint an inquiry officer. The Disciplinary
Authority may also appoint presenting officer to lead evidence before the presenting officer
on behalf of the Disciplinary Authority.
The inquiry officer will issue notices to the A.G.O. to be present before inquiry
officer after getting all relevant records from the Disciplinary Authority,. The A.G.O. shall
appear in person before the Inquiry Authority. The A.G.O. may also take assistance of
another Government Servant or a retired Government Servant who is not a legal practitioner.
The inquiry officer shall ask the A.G.O. whether the A.G.O. is guilty of any of the
charges and the A.G.O. wants to defend. This has to be recorded by the Inquiry Officer and
take signature of the A.G.O.
If the A.G.O. fails to appear before the Inquiry Officer without valid reason for his
absence or refuses to plead, the Inquiry Officer may ask the presenting officer to produce the
evidence to prove charges against the A.G.O.
The A.G.O. may be allowed to inspect any of the documents and permit him to take
extracts of statements listed in the charge memo. The A.G.O. may be allowed to submit a list
of witnesses to be examined on his behalf.
On the date fixed for enquiry the charge witnesses may be examined by P.O. cross
examined by the A.G.O. and re-examined by P.O. if necessary. When the examination of
witness for Disciplinary Authority is closed. The A.G.O. shall state his defence orally or in
writing. A copy of the defence statement should be given to the P.O.
The A.G.O. may examine himself and also examine the witnesses to be cross
examined by P.O. and re-examined by A.G.O. if necessary. The Inquiry Officer can also put
questions.
The Inquiry Authority after completion of production of evidence permit the P.O. to
address his argument and record the same. The Inquiry Authority may also permit the P.O. to
file his written arguments.
After completing enquiry, the Inquiry Authority will draft inquiry report to be
submitted to the Disciplinary Authority. In the inquiry report, the Inquiry Officer will have to
analyse, each charge on the basis of evidence placed before him and record his findings on
each article of charges. These findings will be submitted to the Disciplinary Authority in the
form of inquiry report along with documents.
The Disciplinary Authority after receipt of the inquiry report will examine the report
of the Inquiry Officer and proceed further. If the findings reveal that the gravity of 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 charges is so
severe that, it warrants a major penalty as specified under Rule 8, the Disciplinary Authority
may impose major penalty if he is competent to do so or forward the inquiry report to the
Authority competent to impose a major penalty:
184
3-
If Disciplinary Authority is the Government then before imposing any of the major
penalties, the KPSC will have to be consulted. If the Authority subordinate to Government 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 the
A.G.O., enclosing copy of the inquiry report. There is no need to intimate the penalty
proposed.
3
Against the order of the Disciplinary Authority, the A.G.O. 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 charges,
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 Authority may order joint enquiry under Rule 13. Even in a joint inquiry the
Procedure under Rule 11 or 12 may be followed depending on the severity of the charges.’
The Government can appoint Lokayukta Officers as Inquiry Authority under Rule 11 (4) of the Rules. The Inquiry Authority can in
i____
1. cases modify or alter the articles of
such
charges but they cannot frame the charges on their own.
Special Procedure in certain cases :
The Competent Disciplinary Authority under Rule 14 may without holding any
inqui^ 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 to 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 Financial Code
5. The Indian Penal Code
185
CONDUCTING OF TRAINING PROGRAMME AT PHC & SUB-CENTRES
Dr. Koradhanya Math,
Asst. Training Officer, IPP - IX (K), Bangalore
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 augmented
by Training, to join in the main flow of health services and also to update their knowledge
and skill for favourable attitude and motivation to perform their jobs in an efficient and
effective manner. So training is essential and vital. It helps in orientation, updating the
knowledge and motivating them to become more positive, constructive and productive.
Even after joining the service they are not in touch with academic activities. So there
are serious gaps in the knowledge, skills and practices of the health personnels specially in
regards to family planning, maternal and child health, nutrition, immunization, control of
communicable diseases, environmental sanitation, vital statistics and health education. This
has made an urgent need for training of all categories of health personnels now and then
during their service.
Training - Give instructions or information or practice to make persons more
knowledged and skilled, and it is always reciprocal.
Programme- Plan of inteded proceeding
- list of planned events.
( Greek: programme = public notice)
Programme is always a planned one.
Primary Health Center- place from where the Primary Health care is provide to the
community.
Before Alma-Ata Conference the Primary’ Health care means-basic health services
-first contact care
-easily accessible care
- provided services.
After Alma-Ata Conference the Primary Health Care Means-“Essential health care
made universally accessible to all individuals and acceptable to them, through their full
participation and at a cost that the community and the country can afford.”
Before conduction of training the following points are to be considered in detail as
preparation.
Category of trainees :
T.B.A
V.H.G
AWW.
Medical or paramedical health personnel.
M.S.S members.
Social Workers.
Link workers.
School teachers.
186
N.G.O.S
Panchayat raj-members.
Objectives of training
-
Update their knowledge, skills & practice.
Aware of there jobs responsibilities.
Regular recording and reporting.
Prepare them as trainers to community.
Types of training- Induction -yearly
-in-service
or -seasonally
-random
IV. Place of training - Primary Health Centre
-Sub-centre
-Community centre
There should be feedback.
Through- impressions &suggestions on - coarse contents
- at the time of tea, lunch
- teaching method
-at the end of training
- handouts
-OHP/ slide projector
-suggestions to improve.
VI. Curriculum 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 trainees.
VII. All the participants, guest lectures and field staff where you are giving field
training, should be identified, preferable local or with in taluka. Participants and guest
lecturers must be informed well in time preferably 4-6 weeks in advance. It should not be too
early, so that by the time the training dates approaching it should not be forgotten.
VIIL Training materials :
- Black board & chalk pieces & chalk pieces & duster
- Charts & tables
- Diagrams
- VCP with cassettes
- O.H.P
- Slide projector
- Epidiascope
- Demonstration materials- B.P. apparatus/stethoscope
- Thermometer
- Glovec
Autoclaver / Pressure cooker
-? Scissors / Blade
- Delivery kits
187
Curriculum — Based on category and contents, should be prepared before training
-Cover all the topics mentioned in the contents o': the training.
-Each topic (for example-immurization)
-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
- Variety - makes learning intersting
- Participation- Practical demonstration
-hands on practices
(Chinese proverb “If I hear I forget
I see I remember
I do I understand”
So training should be through,
-lectures.
-practical demonstration.
-hands on practice.
-role play, songs.
-group discussion.
-games, problem solving, case study,
-field demonstration.
IX. Budget:
T.A. & D.A.
Contingency
Guest lecturers/Speaker’s remuneration
POL
The team leader (M.O) may have the diplomacy to mobilise resources
After having prepared all these you are ready to start the training programme. Now it
is not possible to remember every thing by the co-odinator of the programme. So it is always
better to have the check-list.
Check-list- Arrangements -Classroom
hospital
field
Faculty according to timetable- P.H.C
Guest speakers
Training meterials
Vehicle in good condition with driver^ fuel.
Field staff.
188
Problems :
a) Managerial -accomodation
-food
-faculty members
-Office work
-Copying & distribution of back-ground meterials
-Finance
b) Technical -Electricity
- demonstration of instruments
- vehicle
c) Field - acceptability by the community leaders speciall women leaders
&family heads at the time of field training.
189
SYNAPTIC NOTES ON RETIREMENT BENEFITS & TA RULES
Sri. Viswanathan, CAO cum FA, DH & FWS
Every Government employee who enters service has to retire from service. On
retirement on employee governed by the existing pension scheme gets a monthly payment of
pension for life and a lumpsum gratuity at the time of his retirement determined with
reference to the length of service. In the event of death of the Government Servant, his
family gets under certain conditions a monthly family pension for life.
To ensure that an employee’s family gets all retirement benefits in time, it is essential
that employees acquint themselves with rules, and procedures etc. in this behalf.
The determination of pensionary benefits is dependent on the length of qualifying
service. This essential piece of information is available in employee’s service Book /
Service. A service book starts as soon as an employee enters service and all important events
such as confirmation, promotive, grant of increments, grant of leave etc., sanctioned and the
total length of service are recorded in it. The rules provide for annual verification of entries
made in the Service Register by the employee. He should insist on verifying Service Book
entries once a year, without fail.
Eligibility for pension :
A Government employee in a pensionable service, including quasi-permanent or
temporary employment, retiring on super annuation after rendering not less than 10 years
service is eligible for super annuation pension.
1. The Government servant is required to retire from service on attaining the age of
58 years, which is at present. The retirement actually takes effect from the afternoon of the
last day of the month in which he attains the age of 58 years. However, the compulsory
retirement of a Government servant whose date of birth falls on the first day of the month
shall be from the afternoon of the last day of the month preceeding the month in which he
attains the age of 58 years. In the case of Government servant who puts in a qualifying
service of not less than 66 completed six monthly periods (33 years), the pension will be
calculated at 50 percent of the emoluments drawn by him at the time of the retirement. For a
Government servant who at the time of his retirement renders a qualifying service of 20
completed six monthly periods or more but less than 66 completed six monthly periods, the
amount of his persons will be in such proportion of the maximum admissible pension. The
pension so calculated will be subject to a minimum of Rs. 390 /- p.m and maximum of Rs.
3450 /- p.m.
2.
Amount of Gratuity on Retirement:
In the case of a Government servant, who has completed not less than 10 six monthly
periods of qualifying service, the amount of retirement gratuity admissible is lA of the
documents for each completed six monthly period of qualifying service subject to a
maximum of 16 /z times the emoluments (subject to a overall maximum of Rs. One lakh).
190
3.
Commutation of pension :
The Government is allowed to commute a portion of his pension not exceeding one
third for a lump payment. As per the existing simplifying procedure, the Government servant
has to furnish a declaration at the time of retirement regarding his intention or otherwise to
commute pension. In cases where no such declaration is made, the Accountant General will
presume that the retired Government servant has opted for maximum commutation
permissible under the rules and authorises commutation value along with pension and DCRG.
The commuted portion of the pension will be resorted after 15 years from the date of
commutation.
4. For Families (a) Death Gratuity :
In the event of death of a Government servant while in service, the Death Gratuity is
admissible at the following rates :
Length of Qualifying Service
Rate of Gratuity
Less than one year
Two times of emoluments
One year or more but less than five years
Six times of emoluments
Five years or more but less than 20 years
Twelve times of emoluments
Twenty years or more
Half of emoluments for every completed six
monthly period of qualifying service subject
to a maximum of 33 times of emoluments and
I subject to a maximum of 2.5 lakhs
'
'
5. (b) Family Pension :
Family pension becomes payable to the widow / widower or minor sons / unmarried
minor daughters, from the day following the date of death of the employee while in service or
after retirement. It is payable only to one member of the family at a time. The rate of family
pension admissible are as under :
Emoluments
i |~Not exceeding Rs. 1500 /- p.m
Rate
30% of emoluments subject to a minimum
of Rs. 390 /- p.m.
ii
Exceeding Rs. 1500 but not exceeding Rs. 20% of emoluments subject to a minimum
3000 p.m
of Rs. 450 p.m
iii
Exceeding Rs. 3000 p.m
15% of emoluments subject to a maximum
of Rs. 1250 p.m.
In case of Government Servant, who dies while in service after having rendered a
qualifying service of not less than 7 years the family pension admissible will be at an
enhanced rate equal to 50 percent of the emoluments last drawn or twice the family pension
191
normally admissible, whichever is less, for a period of 7 years or the age of 65 years, if he
had survived, whichever is earlier.
In the event of death of both the father and mother who were Government Servants,
the family pension payable to minor children is subject to a total of Rs. 1250 p.m.
6.
Other Types of pension :
a) Compensation Pension : This pension is granted to a Government Servant who is
discharged from public service on the abolition of his post.
b) Invalid Pension : The pension is granted to a Government Servant who is declared by
the appropriate medical authority to be permanently incapacitated for further services.
c) Retiring Pension : Retiring Pension is granted to a Government Servant who is retires
voluntarily or is retired in advance of the age of retirement by giving notice.
d) Extraordinary Pension : This pension is awarded in the form of monthly pensiomto a
widow of a Government Servant or a disability pension to a Government Servant under
the provision of K. G. S (Extraordinary Pension) Rules 1980.
e) In respect of a Government Servant dismissed1 or removed for mis-conduct, insolvency or
in-efficiency, compassionate allowance not exceeding 2/3 of the pension which would
have been admissible had the Government Servant retired on medical certificate may be
granted in cases deserving special consideration and such an allowance is treated as
pension for 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, may, by order in writing withhold or withdraw pension or
part thereof, whether permanently of for a specified period, if the pensioner is convicted of
serious crime or is found guilty of grave misconduct.
8.
Time schedule prescribed for preparation and settlement of pensionary benefit:
i)
After completion of 25 years of service, the head of the office of the office where
the Government Servant is working will forward the service book of the
Government Servant to the Audit Officer for verification and to communicate the
qualifying service determined by the Audit Officer.
ii)
The head of the office will obtain from the retiring Non-Gazetted Government
Servant the particulars mentioned in the proforma appended herewith one year
before the date of his retirement. This proforma and the particulars mentioned
therein will be sent along with other pension documents to the Accountant
General not later than .three months before the date of retirement of the
Government Servant. The Gazetted Government Servant will submit the
proforma one year in advance of his retirement to the Accountant General who
will build up his pension records.
192
9.
Documents to accompany Pension papers :
Upon the retirement of the Government Servant, the following documents are
required to be sent to the Accountant General within a week from the date of retirement.
a) Last pay certificate duly nothing the amount to be recovered from DCRG, such as HBA,
MCA and other advance, if any.
b) No due certificate duly nothing government dues other than those noted in the LPC which
are to be recovered from out of the gratuity payable to the pensioner.
In order to get pensionary benefits, in time please ensure that
i) Nomination for DCRG is furnished.
ii) Necessary verification of service is done after completion of 25 years of service.
iii) Required particulars in the prescribed proforma are submitted to the Head of Office
one year before the date of retirement.
iv) The proforma along with particulars mentioned therein are forwarded to the
Accountant General by the Head of Office atleast three months before the date of
retirement along with N. D. C.
v) LPC is sent to Accountant General immediately after retirement.
10. Preparation of Family Pension Papers.
In the case of death of the Government Servant, while in service, on receipt of
information of the death of the Government Servant, the Head of Office will send a letter to
the family of the deceased Government Servant in form C requesting the family to furnish the
relevant particulars (both forms appended to this breff). This will enable the family members
to get family pension in time.
11.
Anticipatory Pension :
Where it is not possible to forward the pension records to the Accountant General,
within the prescribed time limit. Head of Office will draw and siburse anticipatory pension at
different percentage of last pay with reference to the total number of years of qualifying
service.
Anticipatory Death-cum-Retirement gratuity can also be paid to the pensioner at the rate of
half month’s pay for each completed year of qualifying service subject to a maximum of 15
■ months pay.
12.
Voluntary Retirement:
A Government Servant may be permitted to retire voluntarily any time on completion
of a qualifying service of not less than 15 years. A Government Servant may also be
permitted to retire voluntary any time on attaining the age of 50 years. A Government
Servant who is permitted to retire voluntarily any time on completion of a qualifying service
of not less than 15 years is allowed weightage upto 5 years (Rule 285 (1) (a) of KCSRs).
However, the benefit of weightage is not admissible to a Government Servant who is
permitted to retire voluntarily any time on attaining the age of 50 years (rule 285 (1) (b) of
KCSRs).
193
13.
Retirement in Public Interest:
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 holding a Group A or Group B post and case of a Government
Servant holding Group C or Group D post.
The pensioners are also entitled to medical attendance and to different classes of
accommodation for treatment in Hospitals and Sanatoria as indicated below :
All General and Special Government Hospitals.
Class of accommodation
Monthly Pension Limit
1.
General ward
Not exceeding Rs.500
2.- Exceeding Rs.500 but not exceeding
Rs.750_____________________ ________
3. Exceeding Rs.750 but not exceeding
Rs. 1250_______ ____________________
4. Exceeding Rs. 1250 but not exceeding
Rs. 1500____________________________
5. Exceeding Rs. 1500
Rs. 5 ward or any ward just below Rs. 5
Rs. 8 ward or any ward just below Rs. 8
Rs. 10 ward or any ward just below Rs. 10
Rs.20 ward or any ward just below Rs. 20
P. K. Sanatorium
Narayanaswamy ward Rs.l
Other Sanatoria
B class ward Rs.l
1.
Not exceeding Rs.500
2.
Exceeding Rs.500 but Second class special ward Rs.4 A class ward Rs.2 or any
ward just below Rs.2
not exceeding Rs. 1250 or any ward just below Rs.4
3.
Exceeding Rs. 1250
First class special ward Rs.6 or Special ward Rs.5 or any
ward just below Rs.5
any ward just below Rs.6
194
Synaptic Notes on TA Rules and Retirement Benefits by Sri. Vishwanathan.
Chief Accounts Officer-Cum-F.A, H & F. W., Directorate, Bangalore.
I.
Classification of Government Servants for purpose of Travelling Allowance :
The existing classification of Government Servants for purpose of ’ travelling
allowance shall be revised as under :
Pay range (Per month)
Category
I
Rs.3300
and
more
II
Rs.2150
to
Rs.3299
III
Rs. 1520
to
Rs.2149
IV
Below Rs. 1520
2. Entitlement for Travel by Rail:
The entitlement to railway accommodation of Government Servants for journeys on
tour or transfer shall be regulated as under :
Category to which Government Servant belongs
I
a) those drawing pay of Rs.4325 or above
Entitlement
I Class / AC
b) those drawing pay of Rs.3300 or above but below I Class / AC two tier sleeper
Rs.4325.
II
I Class / AC two tier sleeper
III
I Class / AC Chair Car.
IV
II Class sleeper
3. Daily Allowance :
For purpose of Daily Allowance for halts within the State the revised classification
and revised rates as also revised rates of daily allowance for halts outside the state shall be as
under:
195
Category
to which
Govt.
Servant
belongs.
Halts outside the State
Halts within the State
Other
Places
Rs.
70
Ahmedabad, Bombay, Calcutta,
Delhi, Ghaziabad, Hyderabad,
Kanpur, Lucknow, Madras,
Mussourie, Nagpur,
Pune,
Simla, Srinagar, Goa, Diu &
Daman
Rs.
135
65
55
110
80
65
55
45
90
65
45
40
35
65
45
Bangalore
Other cities
with
municipal
corporations
Other
places
I
Rs.
110
Rs.
90
II
80
III
IV
Rs.
110
4. Special rates of daily allowance for stay in a Hotel or Other Establishment
providing board and/or Lodging at Scheduled Tariffs:
The special rates of daily allowance for halts in respect of journeys on tour outside the
State, in a hotel or other registered establishment providing boarding and / or lodging at
scheduled tariff shall be revised as under :
Places of Halt
Category to Ahmedabad, Bombay, Calcutta, Delhi, Ghaziabad,
which Govt. Hyderabad, Kanpur, Lucknow, Madras, Mussourie,
Nagpur, Pune, Simla, Srinagar, Goa, Diu & Daman
Servant
belongs
Other Places
outside the
State.
Rs.
Rs.
I
250
200
II
200
150
III
150
125
IV
100
75
5. Journey on tour by Air :
A Government Servant drawing a pay of Rs.4325 or above shall be entitled to travel by
air for journey on tour outside the state.
A Government Servant drawing a pay of Rs.3300 or above shall be entitled to travel by
air for journey on tour within the State between the places connected by the Indian Airlines
Services, including the Vayudooth Services.
A Government Servant drawing a pay of Rs.3300 or above proceeding on duty on tour
from Bangalore to any place in Bidar District / Bangalore to Gulbarga and Vice-versa is
authorised to travel by air via Hyderabad.
196
6. Journey by Air on transfer :
A Government Servant drawing a pay of Rs.4325 or above is entitled to travel by air
(including Vayudooth Services) on transfer and claim one fare for himself and an additional
fare for each member of his family.
7. Transfer Grant:
The classification and the rates of transfer grant admissible to a Government Servant on
transfer in public interest involving change in headquarters, from one station to another
station shall be revised as under:
Category to which
Rate of Transfer Grant
Govt. Servant belongs. For transfer within the For transfer outside
District
District.
Rs.
Rs.
I
1200
2000
8.
II
900
1500
III
600
1000
IV
300
500
the
Mileage allowance for journey on transfer by road by owned car or hired taxi:
A Government Servant drawing a pay of Rs.2375 or above may on transfer in public
interest, undertaken journey by owned car or by taxi and may claim single mileage allowance
at the rate of Rs.j.00 per K.M. irrespective of the number of members of his family.
9. Road Journey - Mileage allowance :
The rate of road mileage admissible to Government Servants in respect of road journeys
in owned / hired / borrowed conveyance as laid down in the rule 451 Karnataka Civil
Services Rules shall be as follows :
When journey is performed by
Category
I
II
Ill
IV
Bicycle /
Motor Cycle / Scooter Full Taxi/
Auto - Riskshaw
Foot
Tonga Cycle-Rickshaw Own Car
30 paise per Rs. 1.00 per K. M.
Rs.
3.00 Rs. 2.00 per K.M.<
K.M.
per K.M.
subject to a minimum
Rs.4________________
30 paise per Rs. 1.00 per K. M.
Rs.
3.00 Rs. 2.00 per K.M.
K.M.
per K.M.
subject to a minimum
Rs.4________________
30 paise per Rs.l.OO-per K.. M.
Rs.
3.00 Rs. 2.00 per K.M.
K.M.
per K.M.
subject to a minimum
Rs.4
30 paise per Rs. 1.00 per K. M.
Rs.
3.00 Rs. 2.00 per K.M.
K.M.
per K.M.
subject to a minimum
Rs.4
197
’J
1-!
a'
In respect of road marches exceeding 100 K.Ms a day mileage allowance shall be
admissible at a uniform rate of Rs.3.00 per K.M. in respect of journeys performed by motor
car and Rs. 1.00 per K.M. in respect ofjourney performed by motor cycle/scooter.
r
10. Transportation of personal effects on transfer by engaging a whole railway wagon or
container service:
A Government Servant drawing a pay of Rs. 3300 or above may engage a whole
railway wagon or avail himself of the facility of the container service provided by the railway
service.
11. Road mileage for transportation of personal effects between places not connected by
rail:
A Government Servant on transfer shall be entitled to drawn road mileage for
transportation of his personal effects of the minimum permissible quantity, between places
not connect by railway at the following revised rates :
Category of the Govt. Servant
Rate per K.M. Rs. Ps.
______
1M0
II
6.00
III
3.00
IV
2.00
12. Incidental Charges :
The computation of daily allowance on tour or transfer shall begin when a
Government Servant actually leaves his headquarter and ends when he actually returns /
reaches to the place in which his headquarters are situated whether he halts there or not.
13. Reimbursement of actual cost of transportation of owned conveyance on transfer :
A Government Servant on transfer may draw the actual cost of transportation of
owner’s risk conveyance on the following scales, provided that the distance travelled exceeds
120 kilometers and that the Government Servant is travelling to join a post in which
possession of a conveyance is advantageous from the point of view of his efficiency.
Pay range
Vehicles allowed
Rs. 3825 or above
A Motor car or a motor cycle
Rs. 1640 or above but below Rs.3025
A Motor Cycles / Scooter / Moped or a Cycle.
Below Rs. 1640
A Cycle
198
14. Travel concession to home town :
>■5 4*:7’
:-:v f’
A Government Servant drawing a pay of Rs.3825 or above may after obtaining
specific and prior approval of the competent authority, undertake journey in his own car
namely, by car registered in his own name for journey 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.
*
'4
15. Fixed Travel Allowance :
- ^e fixed Travelling Allowance sanctioned to the following categories of posts shall
k
-- - - -
1.
2.
Junior health assistant (Male & Female)...................Rs. 100/- p.m
Paramedical workers (Leprosy)
..................... Rs. 125 /-pm
; .
' *
offiriPiThe °fnCerS U Staff Wh° have been Provided with Government Vehicles for journey on
official use will not however be eligible for Fixed Travelling Allowance.
Y
I. Pension
Classification of pensions: (Rule 258 of KCSRs)
1■
2.
3.
4.
Compensation pension
Invalid pension.
Retirement pension.
Super annuation pension.
1. Compensation pension : (Rule 259 of KCSRs)
post may G0Vemment
SeIeCted f°r dischar8e from se™ce owing to abolition of a
(a) be appointed to another post, the conditions of which are
are deemed by the
competent authority to be equal to those of the post held by him ;; or
ion or
(b)
,o which he
(c) ^XS07’iXwaccep,i°8 an°'her appoi”,me''t or “ ”ano,hcr
2. Invalid pension : (Rule 273 of KCSRs)
m
inValid,Peilsion is awarded to a Govemment^ervant who is allowed to retire due
i y or menta infirmity, which has rendered him permanently incapacitated :
(a) for the public service, or
199
(b) for the particular branch of it to which he belongs.
3. Retiring pension : (Rule 285 of KCSRs)
A Government Servant may :
(a) be permitted to retire any time after completion of qualifying service of not less than
15 years;
(b) be permitted to retire any time on attaining the age of 50 years ;
(c) be retired in public interest any time after ;
i. completion of 25 years of qualifying service ; or
ii. attaining the age of 50 years in the case of Government Servant holding a
Group - A or a Group - B post ; and 55 years in the case of Government
Servant holding a Group - C or Group - D post.
4. Superannuation pension (Rule 95 of KCSRs)
A Government Servant compulsorily retires on the afternoon of the last day of the
month in which he attains the age of 58 years.
Providing that the date of compulsory retirement of a Government Servant whose date
of birth is first day 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.
II Qualifying Service : (Rule 220, Rule 222 and Rule 224 A of the KCSRs)
(In respect of Government Servant whose retirement or death takes place on 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.
III Period of Service : (Rule 244 A of the KCSRs)
(In respect of Government Servant whose retirement or death takes place on or after first
September 1968)
Time passed on all kinds of leave counts as service under all circumstances ;
Providing that the maximum period of leave without allowance to be so counted is
restricted to three years in the entire service.
IV Suspension, Resignations and Breaks in Service : (Rule 250 and Rule 252 of the
KCSRs)
200
Suspension :
(1) Time passed under suspension if on conclusion of the enquiry, Government
servant is fully exonerated or if the suspension is held to be wholly unjustified,
counts for pension.
(2) Time passed under suspension in 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 the competent authority may declare.
Resignation : Resignation entails forfeiture of past service:
Provided that, resignation with proper permission to take-up another appointment
snail not be treated as resignation of public service.
Dismissal or removal:
Dismissal or removal for misconduct, insolvency or inefficiency and not due to age or
failure to pass a prescribed examination entails forfeiture of past service.
201
Calculation of Retirement Benefits
1. Pension
(Last pay drawn)
X
(Completed six monthly periods of qualifying service)
2
X
66
2. 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 per the table given to rule 380 of the KCSRs)
(Last pay drawn)
X
12
X (Commuted value in number of years of purchase)
3
4. PEG (Pension equivalent of gratuity)
DCRG
12
X (Commuted value in number of years of purchase)
(Commuted table under rule 380 of KCSRs)
5. Encashments of EL
(Pay + DA) X (EL at credit to a maximum of 240 days i.e. 8 months)
202
INDIA POPULATION PROJECTS IN KARNATAKA
Dr. K.B. Makapur, Director, SIHFW
The India Population Projects are implemented with financial assistance from
Government of India and International Development Agency (IDA). Lthis projects are
supportive for the success of Family welfare and Mother-Child Health Programme to achieve
Blrth Rateof 21/1000 population by year 2000 Additional Director (Medical) AND
ALSO OTHER Health Indicators.
The India Population projects implemented in the State are as follows :
1) India Population Project-I, implemented from April 1973 to March 1980.
Area benefited - All the Districts of Bangalore Division with the following
objectives:
-Expansion of Health infrastructure
-linking the provision of F.P. Services with supplementary Nutrition Programme
-Creation of population centre to evaluate performance on continual basis and design
and operate MIES and evaluate performance.
Infrastructure created:
I. Buildings:- i Sub Centre buildings-694
ii Other Buildings -97 (Anmtcs, DH &FW officers and F.P.
Annexure to selected
PHCs, population Centre buildings)
iii Compound walls constructed to Health Institution -417
II. Water Supply:- 784 Buildings
III. Vehicles:- Vehicles provided - 111
IV Equipments:- Equipments supplied of Rs. 120 laks.
India Population Project-III
proiecTwas0^??2^1112'11 °f
yiujcLi was ks. / /.j i crores.
International Development Agency (IDA). The cost of
Objectives
-Generating demand for services,
-Augumenting staff and facilities,
Improving professional and Technical services,
-Improving Management
-Involvement of community, Voluntary organisations,
other Government departments and local bodies in Family Welfare Programme.
Famil Th^Pr0j,ect was imPlemented by the Project co-ordinator with support of Health and
Family welfare department and other departments.
203
Infrastructure created:I. Buildings :
i) New buildings constructed -2344
(Subcentres, secondary Health centres, ANMTCs &LHVTCs, & HFWTCs).
ii) PHC Repaired/Extensions - 83
IL Safe drinking water supply:- 720 Buildings
III. Comound walls constructed:- 654 Buildings
IV. Transport:
i) Four wheeled vehicles -154
ii) Two wheeled vehicles to Mos/BHEs of PHCs -512
V. Equipment & Furniture Purchased and supplied to Hospitals/PHCs :
Rs. 260 lakhs
VI. Training of Medical Officers and Para Medical Staff PHCs :
The IPP-III was implemented by construction wing, An implementing wing and an
IEC wing headed by the Project Coordinator cum Ex-officio Additional Secretary to
Governments
Lacunae in implementations :
1) Delay in implementation of Project Experienced in both project prolonging the project
period from five to seven years.
2) Delay in deputation of staff from other government departments and appointments.
3) Dealy in construction of building due to making the PWD, Land Army Corporations,
Karnataka Construction Corporation responsible for constructions.
4) For obtaining sanctions from Finance and Planning in addition to approval in P.G.B.
due to lack of clarity in the project management at different levels.
5) Delays due to conflict between project staff and Department officers implementing
the Programmes.
INDIA POPULATION PROJECT -IX (K)
The IPP-IX(K) is implemented in the State from 1994 with assistance of Government
of India and I.D.A The IPP-I was implemented in Bangalore Division districts and IPP-III in
the Districts of Belgaum and Gulbarga Divisions. Both the projects covered almost 70%
population of the State and both the projects focussed around health and family welfare
though there were some differences in the emphasis on service components.
The IPP-IX(K) is implemented in 13 Districts of the State ie. Districts of Mysore
Division, Shimoga and chitradurga Qf Bangalore Division, Bellary, Gulbarga of Gulbarga
Division and Bijapur, Belgaum, Uttara Kannada of Belgaum Division as for civil component
is concerned, the IEC and Training component is implemented in 20/27 Districts.
The estimated cost of Project is Rs. 122.09 crores. The Project period is 1994 to 2001.
204
Project objectives:-
j
<
The specific objective of the project is to implement a programme sustainable at
village level to reduce crude Birth Rate, Infant mortality rate and Maternal Mortality Rate
and increase couple protection rate to reach National Target for the 2000 A D
1.
2.
1990
71
Infant Mortality_____
Maternal Mortality
Crude Birth Rate_____
Couple Protection Rate
3.
4.
6
28
47
1998
50
2
20
60
Strategy adopted for achieving the objectives :
1. To involve the community in promoting and delivery of family welfare services.
2. To strengthen delivery of services by providing:
a) Equipment Kits and supplies to TBAs., Subcentres and PHCs.
, .
b) Make ANMs at subcentre mobile by providing loans(Interest free) for ' ’
purchase of Two wheelers.
c) Buildings for subcentres with provision of residental accomodation for
ANMs.
d) Buildings for PHCs.
e) Residentital Quarters to M.Os
f) Construction of Training Centres.s
3' Il^ro^e the quaiity of services by providing training to personnel, official and nonofficial at various levels including TBAs, Community leaders and voluntary
agencies.
J
4. Strengthen monitoring and evaluation by developing and installing MIPS from
District to State level.
No. of Buildings proposed for construction under the Project:
l.Sub-Centeres
2. P.H.Cs.
3. Quarters for M.Os.
4. Training Centres
-1039
-94
-271
-28
Components of Project:1. Strengthening ofService Delivery :
A. Buildings :
i) New Subcentres buildings construction
ii) New PHC buildings construction
iii) M.O. Quarters building construction
iv) Rehabilitation of C.H.Cs. B.H.Us. and subcentres.
B. Furnitures;
i) New Subcentres
ii) Other subcentres
205
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 improvement in knowledge and
clinical skills.
3. Information, Education and Communication :
IEC Equipments, Printed materials, films and vehicles etc.
4. MIES: Computers to be supplied to Districts
5. Innovative Schemes:
Implementation of project:The IPP-IX(K) project is implemented from 1994. The project Director cum Ex
Office Additional secretary is responsible for the implementation of project. He is provided
the following staff.
Director
SIHFW
Joint Director
IPP
Project Director Cum
E/o. Addl. Secretary, IPP-IX(K)
>
S.E.
C.A.0
ANNEXURE -1: Equipment for ANM Kit
ANNEXURE -II: Furniture and Equipment for Subcentre.
Appended
206
Dy. Director
MIES
Dy. Director
IEC
ANNEXURE-I
Equipment for A.N.M Kit
SI.
No.
1.
2.
3.
4.
Item Description
Quantity
Sphygmomanometer aneroid 300 mm with cuff________
Colour coded weighing scale (baby)__________________
Instrument sterilizer ss 222x 22x 41 mm______________
Spring type dressing forceps -stainless steel____________
Basin Kidney enamel 825 ml________________________
~6~ Sponge bowl-stainless steel -600 ml___________ ______
7.
Urethral catheter (12ff) 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)
21. Aluminium shield for spirit lamp
22. Poly urethane self sealing bag (125 x 200 mm)__________
23. Arm circumference scale________
24. Rack Blood sedimentation Westergen 6-3/4 unit_________
25. Adhesive zinc oxide tape (25 mm x 0.9 m) roll__________
26. Tape measure 1,5 M/60” wide vinyl coated_____________
27. Flash light pre focused - 2 cell
28. Kit bag
207
_01
01
01
01
02
01
02
01
01
01
or
01
02
01
01
01
01
01
01
01
12
01
01
01
01
01
01
ANNEXURE -II
Furniture and Equipment for Sub-Centres
I Furniturefor new buildings:
Sl.No
_L___
2. ___
3. ___
±_
5. ___
6. ___
7. ___
8. ___
9. ___
10. __
11. __
12.
Item Discription_________________
Examination table________________
Foot step_______________________
Wash basin with stand____________
Stool__________________________
Cot with mattress________________
Bench for visitors________________
Cupboards for equipment and supplies
Office table_____________________
Side rack_______________________
Chairs_________________________
Container for water storage_________
Bucket with lid
II. Equipmentfor all Sub-centres :
Sl.No
1.
2.
£
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
Item Description_____________
Scale Bathroom
Metric/Avoirdupois: 120 KG/280
LB________________________
Scale infant Metric 16K.GS X
20G_______________________
Colour coded weighing scale
(baby)_____________________
Basin Kidney enamel 825 ml
Basin solution deep enamel 6
litres_____________ ________
Tray instrument/dressing with
cover:310x195x631 mms.s_____
Sheeting plastic clear vinyl 910
mm wide___________________
Brush surgeon’s white nylon
bristles_____________________
Lancet (Hedgedom Needle
)straight 75 mm______________
Tape measure 1.5 M/60 “ wide
vinyl coated_________________
Flash light pre focused —2cell
Sphygmomanometer aneroid 300
mm with cuff________________
Stethoscope Bianural_________ _
Forceps dressing spring type 150
mm stainless steel
208
Quantity
01
01
05
02
01
01
02
02
01
01
01
01
01
01
Quantity
01_____
01_____
01_____
01_____
01_____
02_____
02_____
01_____
01_____
02_____
01_____
02
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
Forcep hemostat straight Kelly
01
140 mm stainless steel_________
Forceps sterilizer (utility)200 mm 01
vaughn Crim_________________
Jar dressing w/cover 0.945 litre
01
stainless steel________________
Forceps uterine vulsellum straight 01
J and above 250 mm___________
Scissors surgical straigth 140 mm 01
S/B stainless steel_____________
Speculum vaginal Bi-valve
01
Cubco’s medium stainless steel
Reagent strips for urine test
100
(albumen and sugar)___________
Rack Blood sedimentation
01
Westergem 6-3/4 unit__________
Cusco’s & Sims vaginal
01
speculum
______________
Anterior vaginal wall retractor
01
Measure Vi and 1 liter__________ 01
Uterine sound _______
01
Haemoglobinmeter set salti type
01
complete set
209
K C S RULES - RECRUITMENT, PROBATION, SENIORITY, PROMOTION
Sri. P. Ramanathan, Consultant, DPAR
A) Application
Applicable (Rule 1 (3) (A)
a) To all Civil Services and posts to which there are no
special rules
b) Even where there are special rules, where these rules
contain an over-riding provision (non-obstatante
clause) or where in the special rules there are no
specific provision.
Not Applicable (Rule 1 (3) (B))
1) To All India Services
2) To Industrial Undertakings
3) To Casual Employment
4) To Work-Charged establishment
A) Methods of
Recruitment
This is the core of the rules. w
The rules give the different
methods of recruitment and the incidental provisions.
Basic Methods of
Recruitment
Exceptional
recruitment
1) Direct recruitment (R-3)
1) Re-employment (R-15(l)
(a))
2) Contract (R-15(1 )(b))
2) Promotion (R-3)
(Note : Of the two methods
the method to be followed
and the qualifications
required shall be specified by
the C & R Rules)
methods
of
3) Transfer (R-16)
4) Deputation (R-16)
1) Direct Recruitment:
Definition ; Appointment otherwise than by promotion,
transfer, re-employment■ or contract is direct recruitment
(Rule2(l)(g)).
There are two methods of direct recruitment
i) by competitive examination;
ii) by selection (Rule 3(1)).
Procedure of Appointment:
210
If by competitive examination in the order of
au,“,y °n ,he basis “f
If by selection, after giving adequate publicity in the order nf
merit determined by the selecting authorities (Rule 4 (1) (b))_
2) Promotion :
Definition
Appointment of a Govt.
Govt. Servant
Servant ftom
from a
post/grade/class of service to a higher prost/grade/class of the
service (Rule 2 (1) (m)).
(Manager Sri V. Rangachari AIR 1962 SC 36).
Here are also there are two methods :
i) Promotion by selection ;
ii) Promotion
Promotion on the basis of seniority-cum-merit Rule 3(1).
n)
Procedure of Promotion :
If by selection
to seniority (Ru,e 4
0 ra «).teiS °f mCn'
d“'
‘') ACfc
'he basis of se™“ records -
c
■ ’ A^Rs’ Personal dossier and SR
Sailer
°f “tron „^y
Union of India - V/s -Srivatsava-1979 (2) SLR 116 SC)
Zone of consideration is 2n + 4 where ‘n’
vacancies.
n is the number of
(iv) Seniority is not
not the
the sole
sole criterion
criterion but
but it
it counts when two
or more persons are of equal merit.
(y) This method or provision is limited to the post of HenH r
the Departments in equivalent grade-Rule 3(2)
S °f
If on the basis of seniority -cum -merit.
?
grade by the lenXFseXice'-Rule f (2) of
Same
Rules.
4 (2) of the Seniority
Xe“R rn.es m Slle„,
211
(iii) If from several cadres or classes of posts of different
kinds, by the other in which the names are arranged by the
appointing authority- Rule 4 (iii) of seniority rules).
(iv) This method of promotion is applicable to all posts other
than HOD and AHODs - Rule 3(2) (b)
(3) RE-EMPLOYMENT:(1) Restricted to appointment of retired Government servants
of the State Government , Central Govt., and other State
Governments.
(2) Terms and conditions are unilateral
one sided
determined by Government under rules.
(3) Period of re-employment as may be necessary and as
determined by the Government. There is no limitation
Rule 15 (1) (a)
(Note:- Extension of service in continuation of service erid it
cannot be granted beyond 60 years )-Rule (15(n) of KCS)
(4) CONTRACT:
(1) Slightly different from re-employment,
(2) Any eligible and suitable personcan be appointed.
(b) Duration of the appointment is normally not beyond five
years.
(OM No. DPAR 15 SDE 85. Dated 11th June 1985)
(5) TRANSFER AND DEPUTATION:-
(i) Government may appoint to a post an Officer of the
Defence Service. An All India service or 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 within State Civil Services.
(m) To effect transfer or deputation from one service to other
the following conditions should be satisfied.
?
(a) Reasons to be recorded in writing.
(b) The post in which the official is working 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
212
the post to which he is transferred or deputed.
(iv) Government may appoint an official who is r—
permanently
incapacitated for the post which he is holding
another post where his services can be utilised or to
Such
appointments
uuiisea.
(a) Cannot be to a lower post unless the official consent to it
for *e duration of S temper^
(6) Government may appoint by deputation of a person to anv
Gn>up-A post m the State Civil Service . If such a pe “n
(a) In the service of any University in India(0) In an equivalent grade; and
’
(c) in possession of specialised qualification;
; .
Period of deputation- not exceeding five years.
C) MATTERS
RELATING to
direct
Recruitment
D) Disqualification :
L'H3 nega‘ive Provisi°n- The qualification i
is, notto possess
the disqualifications listed by the rules.
The disqualifications are:(I) 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
Tanzwa,
(2) a man having more than one wife living3) a woman married to a man already having a wife-
application throng^ pro employment
“Z Z“1 7
,h'
. proper
candidates);
gn -P™P
er channel
^^1 (exception local
(6) For appointment
as peon-not jpassing standard
examination and not
expressing willingness> to serve as
213
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.
" 7
(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
->8 — 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 (1)
(2) If the C & R rules do not provide for enhanced
upper age limits for SCs/STs and other Backward
RuTTp)11611111636 upper age limits wil1 prevail “
(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 age limits.
(a) Relaxation :
mJ0. ?e^C
°f rePatriates
East Pakistan
( angladesh), Burma, Ceylon (Sri Lanka), East African
Countries (Kenya, Uganda, Tanzania, Zambia, Malabi
Zaire Ethiopia) and Vietnam the upper age limit shall be
relaxed;
i) by 3 years for recruitment through competitive
examination
214
1't
n) upto 45 years for all other recruitment;:s ;
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;
D
11)
in)
iv)
who is or was holding a post under the
Government or a local auin
onty or a
authority
Corporation (if the number of years of
service is less than 10 years then by the
number of years of service);
who is physically handicapped
who is a widow
who was a bonded labourer.
2) by 5 years in the case of a candidate;
i)
ii)
3)
for appointment to a Group-B post on the
personnel establishment of a Minister
mister of State or a Deputy Minister
coterminus with the tenure of the Ministerwho is or was holding a post under the
census organization. (If the number of years
of service is less than 5 years then by the
number of years of service);
"“mber Of years »f
candidate;
'■> -he
of a
i)
ii)
who is an ex-serviceman + 3 yearswho is a released NCC full thiie
Cadet
Instructor;
iii) who is or was a Village Group Inspector
under Rural Industrialisation Schemeiv) who is or was a member of the Staff of
Former Maharaja of Mysore.
[Rule 6(3)(b)J
Application through proper channel:
Persons already in Government
service should make the
appointing authority.
application through the
This condition is not applicable to Local Candidates
(Rule 11)
Fee :
215
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.
i)
Exemption of Fee :
i) Total exemption in respect of SC / ST / Category -1;
ii) This exemption in respect of displaced Goldsmiths;
in) Total exemption in respect of migrants from Bangladesh, Burma and Sri Lanka for
recruitment through PSC only.
(Rule 13)
Suitability and Character:
i) to be tested by detailed verification in the 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)
Joining Time :
i) 15 days from the date of despatch of the appointment order by registered post
il) pointing authority may grant such ftirther time as deemed necessary on application
made within time;
in) 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 selected list.
(Rule 18)
Probation :
All appointments by Direct Recruitment shall be
on probation for such period, not
being less than two years.
(Rule 19)
Misconduct:
his recXTmSletf”8 “f'ed ‘'0™,S ” USi”8
me“S
i) criminal prosecution;
ii) disciplinary action;
• iii) debar permanently or 1temporarily by the Commission from admission to an
examination or interview;
iv) debar from employment by Government.
216
Ex-servicemen and
Physically Handicapped
ffi%
reo7,t'rC “ e'e'"“, of dir“' R“"*me„t,
10/o of the vacanc.es available for such direc
recruitment on any occasion shall be earmarked for ex
"forXtem ^^^“^apped persons
P"s ls » reservation under Article 16 (1) of Ute
Consmutton of India.
This is called horizon^
reservation whereas reservation nude. Article 16 4) of
“je Constitution of htdia is called vertical rese™d„°
The horizontal reservation has to be within the vertical
“d
—« reservation shouid
VACCCU JU/O.
For this purpose 10% of the vacancies for Exservicemen 5% of the vacancies for physical^
handicapped and 30% of the vacancies for women shafi
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).
^uunea
(Rule 9 & 3B)
™ S?tiOtn : kAH appointments by promotion shall be
on officiating basis.
The period of officiation shall be ci
be one year unless
otherwise prescribed in the C & R rules.
P16 Per>0d Of officiation may be valued if the official
has already drscharged for the period of one year duties
of the post to which he is promoted.
The period of officiation may be reduced by such
n°t exceeding the period during which the
official has already discharged if any, the duties of such
J-* v/iL*
On .he expiry of the period of officiation either it has to
be declaredJ as satisfactorily completed or the official
reverted.
After declaration.of period of officiation the official
may be confirmed aflhe earliest available opportunity
217
(2) Direct recruitment and promotion are possible only by the methods and procedure
prescribed in the rules of recruitment.
(V.B. Badami Vs 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 Vs union of India 1957 (2) SCR 703 SC)
(V.B. Badami Vs State of Karnataka AIR 1980 SC 156)
(4) Promotions made in excess of promotional quota though not illegal are irregular. The
excess promotees have toe absorbed 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.
J s
(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
ecruitment Rules/recruitment to the date of amendment and them from the date of
amendment to the date of next direct recruitment.
(V.B. Badami Vs State of Karnataka AIR 1980 SC 156).
(2) to (5) above are covered by the Official Memorandum dated 5-7-1976.
IV. SENIORITY AMONG THE PROMOTEES
Promotion in one of the methods of appointment.
(Manager, Southern Railway V/s Rangachari (AIR 1962 SC 36))
Appointment by promotions possible by methods ,viz.,
(1) Promotion on the basis of seniority cum-merit; and
(2) Promotion by section.
The seniority in these two cases is determined as follows:
(1) promotion on the basis of seniority -cum- merit at the same time
(a) If promotion are from any 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 re arranged by the appointing authority.
220
s
4
Commission, where such consultation is
PrOmOti°nS are to be
^om
necessary, after taking^fo^
those cadres or classef of pos^rX 4 (ii^
(2) Promotion by section at the same time;
Departments in the sa^scL^fjay/
°f Departments and Jo>nt Heads of
classes of posts, by tteorcfer InwWch the1131116
appointing authority, in coZXn XThe P
ClaSS °f pOsts or from several cadre or
°rder of merit by the
consultation is necessary, subject to any spedl1 order ofCommission where such
special rules of recruitment. (Rule 4A)
priority in accordance with any
<3’ eqXerit n°‘S°'e CrteiOn- “ c0“n,s <’nl>' «*«“ r™ or ore persons „ „f
(N.K. Panda Vs Union of India (1977 (2) SLR 589 (Orissa))
(4) Seniority brings the officials within the zone of consideration.
(Union of India Vs Srinivasan
1979 (3) SLR 724 V Delhi)
(5) Zone of consideration is 2x + 4 i.
----- . is the number of vacancies.
(6) The principles evolved i ~ ‘
m Badami’s case have been reiterated in Gonal Bhimappa
V/s State of Karnataka
(AIR 1987 SC 2359)
Instruction also have been reiterated by the Government vide Official Memorandum
DPAR 4j SRR 87 dated 14-12-1987
recruits^ouldtMnk app°intment promotees and direct
recruits is the same the direct
mits should be ranked senior to the promotees . (Rule 3)
V. SENIORITY AMONG THE DIRECT RECRUITS
The appointmg authority has to determine at the time of first appointment: Rule 5(i)
®nStere (Ru"5mt” “ te>l'8h “
selecting agencyMe 5 Q™)
th° Order of raerit in Wasnltation with the
Of * COl,ISe °f
tbi a"! .t' y.™”". “ examination is held;
e ection for training if no examination is held. (Rule 5(i) c
221
of
k the
(2) The above principles will apply when the selected candidates assume 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 of seniority and the ranking remains the same.
Syed Shamim Ahmed V/s State of Rajasthan 1981(1) SLR 100 Rajasthan
VI. SENIORITY ON APPOINTMENT BY TRANSFER
(1) When a person is appointed by transfer from one class or grade of service to
another class or grade of service carrying the same scale of pay , his seniority has
to be determined:
(i) If the transfer is in public interest, with reference to his first appointment to
the class or grade from which he is transferred;
(n) If the transfer is at the request of the official, he had 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.
When determining the seniority of a person transferred in public interest with
reference to his first appointment to the class or grade from which he is transferred he has to
e placed at the appropriate place among the persons actually holding the posts in the class or
grade to which he is transferred as on the date of transfer and the seniority of the persons
already promoted cannot be disturbed.(Rule 6)
(2) Transfer does not imean fresh
" ‘ appointment
‘
. Transfer in the interest of
administration cannot be held as discriminatory.
(S.E.R.V/s M.P. Ranga Reddy) 1992 -92 ) SLR 346 Cal).
(j) If the transfer is on request,
request, then
then seniority
seniority has
has to
to be
be assigned
assigned as
as on
on the
the date
date of
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, All India Service a
civil service of the Union or civil service of any other State to any equivalent cla^s
or grade of service in the State Civil Services also has to be determined in
accordance with para (1) above .(Rule 6A)
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
(u) Preparation of a Division -wise list consequent upon posts included in the District
vvisecadre being included in the division -wise cadre :
the distrtf-wise ordistX^wJec!?'0 CO™deration the total length of continues service in
in such is
"SSr
(a> ^2 iXpioXXrmo,ed a lower
,h“
»t
continuous
(h) Where such persons are directly recruited to the distrr
on the basts of their relative age, the older in ------rict-wise/di vision-wise cadres,
age being considered senior to the
younger (Rule 7A
VIII. REMOVAL OF DIFFICULTIES
Service Commission (Rule 8)
’
nsuItation with the Karnataka Public
IX. Preparation of Seniority Lists
•
Z (Ru “w'a^ "
2. The seniority lists have to be prepared by
classes of posts The Crnvprnm^t
1
n ^jazetted cadres or service or
Gazetted cadres of service or classesXosMRure6
nOn'
J
!Very official
SeSsXXlistsC^
a right to know it
the office or are made’ a“bk toXnff0
dlSplayed °n
n°tice board of
official desires a coov of S X J .
t concemed
references. If anv
payment of a nominal price of fifSnaLe31
Sam®,may be suPPhed to him on
the Official Gazette. ?
fty Patse per copy. They need not be published in
nuLSV611101^ liStS Should be invariably prepared
as on January first and
published immediately
(Official Memorandum No. DPAR 45 SRR 80 dt. 29-09-1980)
published before The end ofS™ oTthe^
is prevented by orders of sta^y ofTSs
'
Sh°uld be
UnJeSS SUCh an acti°n
(Official Memorandum No. DPAR 45 SRR? 84 dt. 22-10-1984)
223
X. Seniority list for day to day operation in the event of the existing list
being quashed by the court
1. The High Court of Mysore in the case of one Sri Sunder Murthy (Writ petitions
No. 25 and 137/1966) passed an order on 08-01-1969 to the effect that the part of
ISS list should be remade and until then status-quo shoudl 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.
2. Subsequently, the High Court of Mysore in the case of one Sri Kyathegouda (Writ
petitions No. 888 to 891 etc of 1969) passed an order on 26-08-1970 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 in the event of the final ISS list rectified getting the promotions
would be reviewed on the basis of such a rectified final ISS list.
3. On the basis of three directions Government have issued clarifications O.M No.
GAD 156 INS 70 dated 19-02-1971 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.
PROBATION
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. pie Karnataka Civil Service (Probation) Rules, 1977 Notification dated 25th June 1977
Gazettee dated 7th July, 1977.
1. ’Appointed on Probation’ - appointed on trial - Rule 2(1)
2. Probationer’ - Government Servant on probation Rule 2 (2)
III. 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).
224
4. If the period of probation prescribed in the Rules of Recruitment k
years then the provision in the Rules of Recruitment prevails.
tW°
IV. Extension
00Vemm'”t
'
4' pLeribeT^°«d
»J’b(y\alf ft.
r" dr'“' examination during the
the
is
n
pUJ!ication of the results of examination if he passes- or
• Until the publication of the results of the first of the exam in which he fails
V. Reduction
probationer has drich^Jed'ae'dutie”0' ““'?d‘"8 the period during which ae
I. of the post to which he is appointed, or
• o a post the duties of which are similar and equivalent - Rule 4(2)'
2'
•
in
“/,ten, (1) above-
red“d“"
mce the rules provided for extension as well as reduction of the nmh f
be “
VI. Declaration
period 01Prab»»" should be
declared a
Matters which can be taken into eonsidertion for adjudging the suitability :
U. ^2iS\Pnes™mi“tion7iCe
probation.
d’?inS
Peri°d of Ptohation
KSt/“am'““’"s P«scnbed ,f any, during ae period of
VII. Discharge
discharge ttepr^l* Rpt^lTby"0"" * nOt S“Pit’1' “ “ ,he
post, then it may
Matters which can be taken into consideration for discharging the probationer •
225
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
I. Attitude or tendency - example attempts made by a probationer to secure a
job with better prospect elsewhere (Case Law : TCM, Pillai Vs Technology
Institute, Guindy - AIR 1971 SC 1811).
T
II. Behaviour or conduct - example the conduct which is not in keeping with
the status of the Govt. Servants (Case Law : Kumar Chandra Vs State of
Karnataka - ILR 1987 KAR 2756).
Mis-conduct which has resulted in punishment - A Producer in All India Radio who
committed mis-conduct indulging in loose talk and using filthy 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.
aiscnarge
VIII. Discharge during the period of Probation
A probationer can be discharged even <during
’ ’J_o the
_1__ period of probation on the grounds
arising out of the conditions imposed by rules / orders of appointment- or on account of
unsuitability - Rule 6.
Pr°bationer he may be discharged during the
course ofTrobSn.0115 315 001
k Uasuitablilty 1S another aspect on the basis of which the probationer can be
discharged even during the period of probation.
h;
However, when discharging person under Rule 6
an appointing authority other then
overnment should obtain the approval of the next higher'authority
_. This is to avoid
prejudice resulting in malafides.
’
niu
Recourse t0 Rule 6 cannot be had when miscounduct is alleged. If misconduct is
leged it amounts to removal or dismissal within the meaning of Article 311 and hence the
orders passed have to be in <confonmty
~
with thejYrticIe 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 Vs GOI, SLR 1984 SC 426)
IX. General Aspects of Declaration jind Discharge
.•
1) Under these rules :
I. Any delay in declaration of probation does not give rise to automatic declaration
tor unlimited extension.
since there is provision for
226
i
extension or noddtdTalTdednslonddft^d" 1
pr0vision for
the Govt, servant is continued the pXd^^
automatically declared
P
S ^eemec^ *0 have beeen
(Case Law : Kumar Chandra Vs State of Government - ILR 1987 KAR 2756)
HI. Discharge of a probationer who was already in Government
appointment as probationer results in his reversion Z thadXr'T1^ Pn°r t0
(Vide Note below Rule 5).
mat earIier service or post
mb
IVJ The Prohationer discharged under Rule 5 or 6 has no
right of appeal. That is, in
other words once passed is final - Rule 8.
affectedprobarion^rrndrevSdm T
judicial serutiny. The
t
inter-ference by the judiciL is limiteddPPr°fiChlng ?ef0Urt °r the KAT but
scope of
otherwise. Unless there
is simplicifor or
the orders that the discharge is othtr then ddisT6 “
PaSSed °r reCOrds leading to
However, if there is evidd tn
discharge simphcitor the courts cannot interfere,
and stigma attached, however innouous the re?°rds.t0 ^effect that mis-conduct is alleged
can ask for the production of original records id e”x™ite„gSts
‘iiSCl’!'rge ““ C°“
(State of Maharashtra Vs Saboji - AIR 1980 SC 49)
X. Confirmation
is entitled
be
confirmed at the earliest opportunity ln a substantive TOCy a probationer
may
J>ed to
tote
9.
XI. Increments and Pay
period ofZtataT nTb lt^L,UMfl,ta^,S
fal1 d"e d“rinS <he prescribed
increments that
that fall
fall due
due during
during the
the
increments
extended period of probation - Rule 10
probation, as ^orn^h^ateth^^
expiry if extended period
declaration of satisfactory completion of
notionally
the incremented
to hfm foS’ < PrObat.ioner’s
to be fixed
notionally taking
taking all
all the
i
any
arrears
of
pay
Rule
10.
H
f
h
SerVlce
but
he
is
not
entitled to
any arrears of pay - Rule 10.
XII. Where Judicial Proceedings
are pending
Pending, in a Court^f L^wn/the presc XTpLSd^f
otherwise satisfactorily comnleted th/
jUdiCiaI pr0Ceedings are
• j r P [ d °f Probatlon
227
over and if he has
YELLOW CARD SCHEME - A SCHEME FOR PROVIDING BETTER
ACCESS TO SC/ST POPULATION
Dr. HR. Sathyanarayana, Consultant, KHSDP
Introduction :
The “Yellow Card Scheme” a health check-up scheme for Scheduled Cast and
Scheduled Tribe population began as a pilot scheme in November, 1996 in the five districts
of Mysore, Hassan , Kolar, Raichur and Bijapur. Two PHCs each from two taluks of each
of these five districts were chosen for this. The preparation for this pilot implementation
a) Collection of base-line data on SC/ST population at sub-centre level
b) Training for the district level officers, and some PHC doctors in the form of a
Workshop
c) Visit to households by ANMs to appraise the members on the date and venue of
medical examination camp and to fill up basic data on the yellow Card and
d) Distribution of drugs to the PHCs got dispensing to patients at camps.
This special target intervention benefits all the members of the SC/ST households in
in
rural areas through an annual health screening exercise in which
a) Each member will undergo a thorough medical examination which includes simple
laboratory examination of urine, blood and stool to identify and disease at an early
stage.
7
b) Individuals with illness, would be treated in the camp or referred to higher hospitals
c) All women m the age group 10-60 years will be screened by syndrome approach for
any gynaecological disorder and treated where necessary.
d) Basic Health information concerning in nutrition, personal hygine, environmental
chiM3110112111(1 reproductive healtil wil1 be imparted to all and specially top women and
C°ndUCtS
health check-uP
*e SC/St population is led by the
Medical Officer of the PHC and has the following composition.
Team Leader : The Medical Officer of the PHC
Members
: Lady Medical Officer
Senior Health Assistant (Female)
Senior Health Assistant (Male)
Junior Health Assistant (Female)
Junior Health Assistant (Male)
Lab Technician
facilitiplf venue.of the health check-up is the village clinic or the sub- centre if suitable
“es for examination do not exist at the village clinic. A mobile team will carry out the
ti™
IOn bL 0,r?aniSmg welI'Planned eamps at these clinics on pre-notified dates and
times. During health check-up drugs are provided to themeedy patients.
228
1
District
Mysore
Hassan
Kolar
Raichur
| Bijapur
Xof
4:
districts of the first ph:
Examined/Screened
~
7105
12258
~
4898
9569
~
18158
~
Treated
5519
6735
3152
6545
7356
Referred to Hospitals
105
________ 35_______
________ 12________
12
68
Rapid evaluation of Yellow Card Scheme:
stem
Scheme wes de™ by
beneEc^es. The cab.e be,™ gires demiis of ^ hle^
District
Mysore
Hassan
Taluka
PHC
T.Narasir)ur
Mugam
Talakadu
Nanjangud
Hosakote
_____ Tagaduru
HolenEaipur Padarathippe
Bakenahally
Arasikere
Dodda Betta
Javagal
SC/ST
population
~ 9676
4722
7436
3994
6757
3817
5353
10217
Screened at
Camp
655
950
"^4879 ~
1621
3861
2170
4039
1313
"'ere observKi ■ of
veWcles^oXcXrXrone’r f “
Treated at'
Camp
~ 655
915
2591
1458
0
0
0
0
availability of
Ca?PS at the Vllla§es> non availability of drugs
<1T8 lab<>“ra’orT ch“ks
lack of 1EC
Were
m°St im>’°na”t b
for treatment lack of suitfblf e
§
materials to ciavey the m^e rf
98 the programme^XX s Je
Operationalisation of Yellow Card Scheme during 1997-93,
Am.exurePl”„leTfcXPt'SXXftS
97'’8 “ Sh°™ “
Planning, Co-ordination and Supervision :
SC/Sl pXSTt ?he Vvrio™ STeT
|V“ COnd“tin8 hea,th ChKk^
centre level in each district has been, fin T H iS Programme for conducting camps at sub
sub-centres and PHCs Se dfstric
I3
mt° the graphical distribution of
account^gazetted'state
o...
", “
x:-s— s-- —a
229
monthly intervals. This Annexure II is specific for each district and Government has already
given its approval for holding the camps at the said dates. At any cost these camps will have
to be held on the designated date. However, on account of any unforeseen situation if the
camp date has to be changed it can be done only with the approval of the Director, Health
Education & Training, Bangalore and information rergarding such change contemplated must
be given to the Director, HET at least 15 days in advance.
The Director, Health Education Training has been designated as nodal officer for
implementing the Yellow Card Scheme. He and the Consultant of KHSDP would visit the
districts to appraise the details of the Yellow Card Scheme to the implementing officers. In
addition the Government have designated the following officers of the Health Dept, to
monitor the implementation of Yellow Card Scheme in various districts of Karnataka.
Sl.No
1
_2____
_3___
_4____
_5____
_6____
_7____
_______Designated Officer
Director, Health & Family Welfare Training Centre
Additional Director, Strategic planning Centre____
Additional Director, Family Welfare
Additional Director,CMP_______________
Additional Director, KHSDP
Additional Director, IPP-IX__________________
Additional Director; KFW
J__ Joint Director, KHSDP
_9____ Joint Director, CMP
10 ___ Joint Director, Planning
11 ___ Additional Director, AIDS
12___ Joint Director, AIDS
13
Joint Director, MCH & FW
“
14 ___ Joint Director, HET
15 ___ Joint Director, Medical_____________
16 ___ Joint Director, IEC
_____
17 ___ Divisional Joint Director________
18 ___ Divisional Joint Director___________
19 ___ Divisional Joint Director ____
20
Divisional Joint Director
District
Hassan___________
Mandya__________
Bangalore Rural
•
Madikeri_________
Shimoga_________
Chikkamagalur
Bidar
Kolar
~
Raichur__________
Dharwad
Bellary ________
Dakshina Kannada
Uttara Kannada
Belgaum_________
Chitradurga_______
Tumkur__________
Mysore__________
Bangalore
Belgaum_________
Gulbarga
thp p THe ab°Ve <?esignated officers wil1 have to visit the district at least once a month see
meAV3118™!'13 bemg d°ne ln
Camps review 1116 availability of the doctors and
nf th
In
J2"?5
Wl1 aIs° meet 1112 concemed CEOs of ZPs and the Dho and DS
th 6 dlf,riC? and advice them suitably about the implementation of Yellow Card In turn
they would give a feed back to the Director, HET who is implementing the programme.
District Level:
level havetSv
imPlementation of yellow Card Scheme at distri
:nct
level have already been constituted vide G.O.No. HFW 16 COM 95 as follows:
a) District Level:
Chairperson: CEO, Zilla Panchayat
Secretary : District Surgeon
230
Members
: 1. District Health & Family Welfare Officer
2. Asst. Director, Women & Child Welfare Dept.by-invitation.
3. District Social Welfare Officer
4. Representatives of 2 NGO/VO where available
5. Lay Secretary of the District Hospital
also ha^ nv1StnCt leVSl COmmittee wil1 ensure the implementation of Y CS planned It will
also have overall powers to constitute committees at taluka and village orgX tra
"ZX^dditimuj'1™^6. n' V“°“S k™'3
additi°n ““
-W
e. , ?
,0,nt Dlrec,or “ at,e,“, ,he distri« level whenever such reouests .re
e ate level monitoring officers (Addl. Director) must attend it without fail.
Taluka level:
The taluka level committee constituted is as follows:
Chair Person: Executive officer of the Taluka panchayat
Secretary : Taluka Medical Officer.
Members : Member Taluka parishat.
Women Member Taluka Parishat.
■
diTtalul^Hovmver, ^norder^o^ee^rn'prTmaimne1^
XTmX office’ 'i'S":1 S"b 'Omn,i"e'
COnS'it“Kd
chaimmship
1) Chair person & Convenor: Taluka Medical officer
embers
0 Administrative Medical Office of all PHCs
2) Senior Staff Nurse working in the taluka
3) Senior lab technician working in the taluka
4) Senior ANM working in the taluka
5) Senior most LHV in the taluka
6) Senior most Health Assistant-male
Whatev^SZ^"
notice of the taXoXX
■”on,h
8
"view the implementation of the YCS
have to be brought to the
Sub-Centre Level:
In order ,o enabie rhe community pafficipation the fpiiowing eommt^e hXTconXed '
Chairperson: Medical officer of the concerned PHC
Secretary : ANM of sub-centre
Members : Health Assistant (Female)
Head Master of one Secor^ary school / Primary school
Anganawadi worker
231
Training Needs of Yellow Card Scheme :
A Training/orientation programme to train/orient the various categories of health
officers and workers as well as other participarting sstaff will be implemented. The training
will emphasise the need for a well motivated, committed integrated approach and efficient use
of professional and communication skills. Promotional and preventive aspects of health
service delivery will be stressed. The broad components of the training objective are:
a) Refreshing interpersonal skills of communij cation
b) Refreshing professional skills of exzamination and management
c) Retraining on medical information and team spirit.
The catergories of officers, workers amnd community personnel who would be
trained/oriented are:
a) District and Taluka Level Officers: 1) CEO of ZP, DHOs, Distrrict Surgeons
2) Lady Medical Offiecers
3) Taluka Medical Officers
4) Medical Officers of PHCs
b) Health Workers
b) Workers of other Departments
And community participants:
: 1) Senior Health Assistant (Male)
2) Senior Health Assistant (Female)
3) Lab Technician
4) Junior Health Assistant(Male)
5) Junior Health Assistant(Female)
1) Anganwadi Workers of ICDS
2) Members of Ngo Community
3) Women & SC/ST members of gram
Panchayats
4) Women workers social welfare department.
The training programme will be planned at different levels as given below:
a) A one day orientation workshop of trainers and supervisors at district levels for
Medical Officers of district health office and taluka medical officers will be held to
describe the needs and objectives of the scheme, modalities of its implementations and
to issue training guidelines for junior level workers. The district health officers will
conduct a workshop for 16 participants at their district headquarters. The day can
coincide with the monthly district health management committee meeting.
t w Zc Uka medlcal officer win conduct a one day workshop for 20 M.Os and
at
taluka t0 °dent 1116111 on the scheme
its implementations. A total
ot 3-00 in all 20 districts will participate.
c) The taluka medical officers will train 80 senior & junior health assistants (both male &
temale) of the taluka in a one day training programmme at taluka headquarters. He
will be assisted by the PHC medical officers whom he may draft for the purpose. The
training will be for three batches and only refresh the knowledge and skills of the
workers in MCH and FP services, but also train them in mass health screening
methods and screeing of disorders of women'by syndrome approach, 12800 workers
will participate in all the districts.
232
d) mXsTf sS:s“xsxs' lo^srrr
community mobilisation. A total of 79000 will participate
IEC Activities under Yellow Card Scheme :
toln'^ieTS^ td^co^a* Te'r1^'
, location non-governmental organisation where available women memh
P
p
take advantage of the scheme by community for the health check-up in M ,
■hX^XX;^”'6 “ aCti°n
PHC “d S“b'“”te levels'^arry™
a)
Enlisting locally available NGOs i
b)
7‘
‘
■—
-------
»»4AK/
•
Collecting names of women & SC/ST
social wel&are and [CDs depart^ mCmb'rS °f ,’“Chaya,■ “'““-“■to
social welfaare and ICDs departments.
d) Identifying teachers of primary/secondary
e
—y—j schools in the
village who would
<^cation of the chUdren in the schools about the schemes.
e) Local leaders Political and who wield influence
---------- j on the community
c)
-
—-
—WVAAW/AM
UUVUl
11
All IEC materials prepared would be p
Te-tested for their aggreability and impel before
being finally used.
Logistic Support for Yellow Card Scheme :
YelloW C“ds “d P» °f “■= EC materials
will be supplied be be
.!?°d
applied by the Government.
would serve as a drug storage for aH S?-3 S’?* T, pharmacy in each district which
S' xs;-—tSSE
?'=
“
■=
ssss:
——— ».~;a sas,"
233
Gynaecological examinations of women aged between 10 & 60 years is an important
component of the scheme. The special examination equipment and materials required for this
need to be worked out in consultation with the lady medical officers deployed for the scheme
and supplies ensured in advance. Materials such as disposable gloves would be adequately
available to guard against spread of sexually transmitted diseases and AIDS. Adquate
privacy is mandatory for this exercise. For outreach camps, the equipment and staff will
utilise either the PHC vehicle where available or hire a private vehicle by using Rs. 400/allocated for the purpose.
Regarding the location of the camp the camp must be conducted in places like schools
which are mostly public buildings. The camps must be conducted between 10 am to 6 pm.
Regarding locating the health check up facilities in such public buildings the PHC medical
officers is requested to use his discretion however, as a matte suggestion layout plans for
holding the check up camps in public places where there are 3 rooms or 4 rooms or 5 romms
have been provided along with this report in Annexure III.
In order to conduct the health check up camps a detailed flow chart has been provided
in Annexure IV & V. These flow charts clearly indicate the sequence of activities that will
have to take place during health check up camps. The objective of the Yellow Card Scheme
is to see that the disadvantaged sections of the society do get a better access to health.
fi^lise mobile health teams for the sub-centres. Arrangements would
con0/
3 Iady medical offlcer on honorarium where one is not posted? An allocation
° \ t , Per.camP has been made for the purpose. Training materials such as flip charts
note books stationery, ledgers and report books will all be made available. A master sheet
recording all findings of the examination would help future analytical studies and evaluation,
rk 1S matS ,SCreening of the SC/ST population will generate abundant health information on
e morbidity pattern over the project years which may have implications for future
herapeutic, epidemiological and public health interventions. The available computer skills
an equipment at taluka levels could be used to advantage in the camps to collect useful data
wbpn
astern of information storage and analysis could be build from this base
of the
COmpl™ent °f MffiS IS put in place. A monthly reporting system on all aspects
f the scheme would be followed from PHC to talukas and on to districts. Some inclusions
have been made in the Yellow Card.
mciusions
k
j
BUDGET REQUIREMENTS FOR YELLOW CARD SCHEME
FOR THE YEAR 1997-98
1. Drugs :
2% of SC/ST^6 P^hase of druSs for ad the districts for the year 199-98. On the basis tht
1 sn
P°PU a 10n atten^^nS t^le canips would be sick and would need drugs worth Rs
XdLT, PerSK°,n- J1\dn‘SS "J11 b' pr0“re<i “ >»' «“»"«■ Competitive Bijdin.
procuremen the^d 'o'
10 SKrt
Camp
A“8ust ‘97- If th'” » <l=l« in
nnrrh
^rU§S required for the camps m August and September ‘97 will be
purchased by local shopping.
-
234
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ANNEXTURE TO THE GOVERNMENT ORDER NO. HEW 336 HSM 89 DATED
19™ MARCH 1997
DUTIES AND RESPOSIBILITIES OF JUNIOR AND SENIOR PHARMACISTS
A. Duties and Responsibilities of Junior Pharmacists:-
1. The junior pharmacist shall work under the control of the Senior Pharmacist
whenever the services of the senior pharmacist are available, under the over all
control of Resident medical officer / Administrative Medical Officer / Chief
Pharmacist as the case may be.
2. The junior pharmacist shall discharge all the duties and responsibilities of the
Senior Pharmacist, in such institutions where the services of the Senior
Pharmacists are not available, under the control of the Administrative Medical
Officer / Resident Medical Officer / Chief Pharmacist as the case may be.
B. Duties and Responsibilities of Senior Pharamacist:1. The Senior Pharmacist shall work under the control of the Chief Administrative
Medical Officer / Resident Medical Officer / Chief Pharmacist, as the case may be.
2. He shall work in the following sections of the hospital (a) Main store (b) Sub-store
(c) Dispensary (d) I.V. Fluid manufacturing sections.
a) Main Stores:-
He shall be responsible for the updated maintenance of the following records and
registers under the control of Administrative Medical Officer / Resident Medical Officer /
Chief Pharmacist, as the case may be.
(1) Indents for procurement
(2) Daybook of receipts.
(3) Inventory stock book.
(4) Issue register.
(5) ‘BIN, Card / Shelf Card.
(6) Expiry date register.
(7) Adverse drug reaction register.
(8) Drug sampling and test reports.
(9) Inspection book.
(10) Records of demand and supply.
b) Sub-Store:He shall be responsible for the updated maintenance of the following records and
registers under the guidance of Administrative Medical Officer / Resident Medical Officer
I Chief Pharmacist, as the case may be.
(1) Indenting Register.
(2) Issue Register.
271
(3) BIN Card/Shelf Card.
(4) Inventory Register.
(5) Adverse Reaction Register.
(6) Inspection Book.
(7) Expiry Date Register.
(8) Statistical data of demand and supply of drugs.
C) Despensary: He shall be responsible for the updated maintenance of the following records and
registers under the guidance of Administrative Medical Officer / Resident Medical Officer
/ Chief Pharmacist, as the case may be.
(1) Indenting Register.
(2) Issue Register.
(3) Master formula chart for various preparations.
(4) Statistical data of demand and supply of drugs.
(5) Diseases statistics (As per the Govt. Order No. HFW 195 PTD 85, dated 7-11986).
D) I.V. Fluid Manufacturing Section
He shall be responsible for the updated maintenance of the following records and
registers under the control of Chief Pharmacist / Graduate Pharmacist as the case
may be.
(1) Preparation of Labels.
(2) Label consumption data.
(3) Issue register of I.V. Fluids.
(4) Receipts register of returned empty bottles from the wares / units and other
indenting institutions.
(5) Log book of machinery operations for each machinery.
3. In all the registers and records he shall identify each entry of the drugs with
standards, strength, batch number expiry date and make besides other information
specifically required and instructed by the controlling and / or inspecting officer.
4. He shall verify in random that items newly received with respect to
(1) Order placed.
(2) Label specification.
(3) Volume / Weight / Quantity by count / Measurement with respect to label
claims for consistency / uniformity etc..
5. a) He shall cany out certain qualitative simple phys-co-chemical tests too as
certain the quality of drugs and maintain record of such works and submit his
observations to the Chief Pharmacist / Resident Medical Officer / Administrative
Medical Officer as the case may be indicating the action may be taken.
272
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4
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b) He submit the proposed for details testing of the drugs found failing to pass the
qualitative tests.
6. a) He shall maintain the entire storage area in clean and hygienic conditions.
b) He shall maintain the stocks in an order and in such a way that no item is
stored unduly in excess
c) He shall follow the specified storage condition for each drug, so that no drugs
loss potency during storage.
d) He shall keep all ‘POISONOUS DRUGS, EXPENSIVE DRUGS
NARCOTIC AND PSYCHOTROPIC DRUGS’ separately under look and lye
as per technically viable administrative decisions.
7. a) He shall prepare indents for procurement after obtaining the requirements from
the Medical Officers or from the various units in the hospital and based on the
statistical date of demand and supply of each item.
b) He shall prepare only the need based indents> so that neither scarcity nor the
wastage occurs.
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2
8. He shall prepare the annual expenditure programme within the following
limitations:-
(1) Budget availability.
(2) Needs of emergency drugs, life saving drugs and essential drugs and OPD
Drugs which should be available throughout the year and needs of desirable
drugs.
(3) Storage capacity.
(4) Demand.
9. While in I. V. fluid manufacturing sections of hospital pharmacy he shall assist the
Chief Pharmacist in the manufacturing and testing including animal house
maintenance.
10. In the dispensary, he shall carry out the work as under:«
(a) He shall prepare the mixture as per the master formula / National formulary of
India / presentation.
(b) He shall dispense the drugs as per the presentation and explain to the patient /
attended the full drugs dosage gagimen and therapautic discipline to be
followed during the theraphy.
(c) The drugs like tablets, capsules, etc., should be neatly packed and the ‘Name’
and ‘Dosage in non-verbal form’ should be mentioned on the pocket before
dispensing.
w
(d) He shall bring it to the notice of the prescriber any interacting combinations /
over dosage / history of sensitivity of the patient known to him, which might
have been inadvertently crept in, without alarming the patient, in the best
273
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T
interest of the patient and theraphy. It should be noted that such infomiation
are not binding on the prescriber.
i
11. (a) He shall participant in the various health education programmes of the
institution.
(b) He shall participate in the Therapeutic assessment of quality of drrugs in the
hospital.
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