Synopsis of the Hospital Management Training for C.H.C. Medical Officers
Item
- Title
-
Synopsis
of the
Hospital Management Training
for C.H.C. Medical Officers - extracted text
-
tA
1
i
X
Synopsis
of the
Hospital Management Training
for C.H.C. Medical Officers
Sponsored by the
Karnataka Health Systems Development Project
1999-2000
i-i f.
Conducted by the
State Institute of Health & Family Welfare
Bangalore
INDEX
SI
TOPIC
NO.
Page No.
01.
Organisational set up and Fuctions of
Health and Family Welfare Department
and Powers of Taluka Level Health Officers
1-12
02.
Over-view of KHSDP, Referral System
13-44
03.
04.
04.
Trauma Care, Orthopaedic Emergencies
Office Procedures
Hospital Infectious and Control Procedures
45-52
53-56
57-60
06.
Blood Banks and Trauma Care Centres in
Karnataka
OJ.
61-70
Management Information System in
Karnataka Health Systems Development
Project (KHSDfc)
71-82
08.
Hospital Administration
83-86
09.
Management of Drugs, Procuring, Storing
and Utilisation
87-98
Recruitment, Seniority, Probation,
Joining Time, Increment, KCSRs Leave
Rules
99-130
11.
Departmental Enquiries
131-136
12.
Hospital Waste Management Training
for CHC Doctors
137-146
Contracting out Services in Hospitals
under KHSDP.
'147-156
Doctor.- Consumer Protection and
Adjudication of Liability
157-172
15.
Quality assurance and Medical Audit
173-180
16.
Types of Pensions, Calculations DCRG
and Other benefits etc..
181-196
17.
Delegation of Powers - G.O.
197-206
18.
Budget Mannual
207-214
19.
Prevention and Detection of Fraud in
Financial Management in Government
215-230
10.
£
13.
14.
20.
21.
National AIDS Control Programme in Karnataka 231-238
Prevention and Control of Emergining and
Re-emerging infectious Diseases
239-258
22.
Responsibilities of Drawing and Disbur
sing Officers
259-274
RCH Services
Diet Management
275-288
289-298
23.
24.
7
I
fr
™D ™ii'y
skasZSSiz
--------- --- ^LUKA LEVEL HEALTH OFFICERS
Under the Constitution of India
Health •Is a State
Subject. It is the
responsibility of State
Governments
to provide all Health Care Facilities
Health Care
to its Citizens.
Accordingly, to fulfill the above
responsibilities, the .
State Government has set
up the Health Care facilities
on j.
the guidelines
of Government of India and
upgraded the
f.clUU.. ,M c„,Ma neu faollUiBs
P '
to
provide comprahensi ve
Health Care facilitle
3 in the State.
The National Health and
Family Welfare Programmes are alwo
implemented as
Por guidlines of Government of India for
prevention and control of
Communicable Diseases Viz.,
Malaria, Failaria,
Tuberculosis, Leprosy, Gustrcenteriiis/
Cholera and other Vaccine
preventable Disease. Control
of Non-Communicable
Diseases like
Iodine deficiency disorder,
Diabetes, Cancer
ate., are also implemented in the State.
The following Health
Care.Services are
in the State:
provided by Government
1) Promotive Health Care
Services
2) Prevention and Control
of Diseases
2) Curative Services
4) Rehabilitative
Health Care Services
To provide Comprehensive
Health Care Services
created and providing Services
/
tte State has
at the following Levels:
. 2
I
-: 2
5
1) Primary Health Care Services
2) Secondary Health Care Services
3) Tertiary Health Care Services
- at Sub-Centre,
PHC and PHU.
- CHC, Ta Iuka Level
Hospitals and Dist..
Hospitals.
- Major Hospitals,
Super Speciality
Hospitals, Teaching
Hospitals.
SUB-CECTRES:-
There are lowest level Health Care facilities. headed by a
Junior Health Assistant (Female) for every 5,000 Population in
the Plain areas and 3,000 Population in the Hilly and Tribal
areas.
These Sub-Centres provide Primary Health Care Services
incljxdirfglo RCH Services.
A total of 0,143 Sub-Centres are
established in the State as on 31-03-1999.
These Sub-Centres
activities are supervised and managed by the Medical Officer
of PHC/PHU.
PRIMARy HEALTH CENTRES
These Centres are provideing 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
a Medical Officer assisted by Para-Medical 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:
. 3
3
) Surgery
2) Obstetrics and
Gynaecology
3) Paediatrics
4) Dental Care Services
These are 242
Community Health Centres
functioning in the State;
These Centres are
being expanded.
upgraded under Karnataka
Health Systems Development
Project and KfW Project. .
DISTRICT hospitals :.
27 District Hospitals
are working, the
District Hospitals of
New Districts are
being upgraded and
expanded for providing
Secondary Health
Care Services. These District Hospitals are
developed under Karnataka Health
Systems Development
Project
(KHSDP) and KfW Projects In
the State. These Hospitals
will
provide 14 Speciality Services
with 250 beds to 600 beds.
Government of Karnataka has
s^t up the Organisation
of Health
and Family Welfare
to provide Health
Care Services.
STATE HEADQUARTER • -
Minister for Health and Family Welfare heads
Secretary to Government, Health and
the Department and
Family Welfare Department
The Medical Education
was one of
the wings of Health and
Family Welfare Department
earliar, now
it is a separate Department
with Minister and Secretary.
Three Departments
work under the control of Health Secretary:
1) Directorate
Health and Family Welfare Servicea
2) Directorate
of Indian System of Medicine
3) Dfugs Controller
works under the Minister,
directorate of health and
family welfare SERVICES?
Earliar Director of Health and
Family Welfare Services was head
of the Department and
was working under
the Health Secretary.
Now during May I999
a post of
Cormissionsr fOr Health (in
Cadre of Secretary to
Government) has ^en created and
filledup.
will be
Co-ordinating the activities of
all the wings of Dfrectrate, and looks after the
Policy Matter.
. 4
4 :-
h.
The Director of Health and Family Welfare Services is the
Head of the Department and responsible for the Planning, Imple
mentation and Monitoring of all Health Care Services in the State
He is assisted by Chief Administrative Officer, Chdk4f 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 Heads af the Office, and four Divisional
Offices are functioning at four (04) Divisional Head Quarters
with supportive Staff.
DISTRICT LEVEL ORGANISATION:The District
Health and Family Welfare Officer is the Head
of Organisation, controlled ,by Zilla Panchayat at District Level.
He assisted by Gazetted Assistant and Programme Officers.
TALUKA LEVEL ORGANISATION:Taluka Level Health Officer post is sanctioned for each Taluka to
Plan, Implement, Monitor the Health Care activities in the Taluka
area, who will be supervising and Monitoring the activities of PHCs
in the Taluka and Co-ordinates activities of Department-with—other
Departments.
BELOW TALUKA LEVEL:-
Primary Health Centres are established to provide Primary Health
care Services in the Rural areas and each PHC has 6-8 Sub-Centres
for carrying out the Implementation of National Health and Family
Welfare Programme in addition to providing of Primary Health Care
Services.
SUB-CENTRE:-
It is the
lowest periphral Health Organisation
established for providing Primary Health Care Services and Imple-
mentation and National Health and F.W. (RCH) Progrerimes in the areas.
The Chart showing the Organisational set up of Departments ,
is given in Annexure I tolVT.
The Administrative and Financial Powers of Taluka Level
Health Officers is appended.
karnatakA
Demographic Seen* at a Glanee
01. Karnataka is
one of the 8th Major State in India.
02. Geographical area
• 1.92 Lakhs Sq.Kms.
03. Projected Population
-05 Chores
04. No. of Revenue Divisions
- 04
05. No, of Districts
-20+07 New Districts
06. Taluks
- 175
07. Urban Population
08. Rural Population
09. Male
10. Female
- 2.30 Crores
11. Sex Ratio
- 2.20 Crores
- 2.40 Crores
- 3.10 Crores
-960 Females/1000 Males
HEALTH institutions IN KARNATAKA
01. Total No. of Health Institutions
- 2,336
02. Total Bed Strength
03. Teaching Hospital s
04. No. of District Hospitals
- 38505
- 17
05. No. of Hospitals 50—100 Beds
06. No. of Community Health Centres
07. No. c
of- Primary Health Centres
(GOIP 262
MNP 1332 ).
08. No. of Primary Health Units
09. No. of Sub-Centres
10. No. of Maternity Annexes
11. Population Bed Ralo
-20+07
- 52
- 242
- 1601
- 589
- 8143
- 279
1*428/1000 Population
PARA ~ METER
demographic
01 • Annual Growth Rate
- 1.9%
02. Decimal Growth Rate
- 21.11%
- 23
03. Birth Rate
04. Crude Ddath Rate
05. I.M.R.
06. M.M.R.
- 7.3
- 53
- 4,5
07. Reproductive age Group (f)
08. Life Expectancy
Male
M
09.
Female
10. Mean age of Marriage of Girls
BEDS
distributed
- 15-29 Yrs,
- 65-55 Yes.
- 66-55 Yfs.
- 17.4 Yrs.
IN HEALTH
District Hospital
Taluka Hospitals
Community Health Centres
Primary Health Centres
Population Bed Ratio
INSTITUTTONS
250 to 750
2 Million
30 to 100 and above
30 to 50 beds
06
1.428/1000 Population
MYSORE TYPE OF dispensary/ PHU
Primary^alth Unit
-589
Sanction
- of
-- Primary Health
--- i Units
POPULATION
15,000
stopped since 1984,
COST
06 Lakhs
£
ANNEXURE - I
ORGANISATIONAL SET UP OF
HEALTH AND
FAMILY WELFARE DEPARTMENT
ECRETARIAT LEVEL:
MINISTER OF HEALTH AND FAMILY welfare
GOVERNMENT OF KARNATAKA
1
I
I
DEPUTY SECRETARY (HEALTH)
I
I . F.A
T
T“
UNDER
SECRETARY
SERVICES
UNDER
SECRETARY
C&R
UNDER
SECRETARY
HEALTH
UNDER
SECRETARY
R & I
UNDER
SECRETARY
I.S,M .
UNDER
SECRETARY
LEGAL CELL
ANNEXURE-II
SECRETARY TO GOVERNMENT
HEALTH AND FAMILY WELFARE DEPARTMENT
DIRECTOR .
I .S ,M .
DRUGS
CONTROLLER
COMMISSIONER.FOR
■ HEALTH ANO FAMILY
WELFARE
i
PROJECT DIRECTOR^,
IPP-IX(K)
I 0
S pt- <>cc/us
"T o G) o
*
DIRECTOR
STATE INSTITUTE
OF HEALTH AND F.W.
DIRECTOR
HEALTH AND FAMILY WELFARE
SERVICES
PROJECT.ADMINISTRATOR
1
I
CUM E/O SPL .SECR^TA^.Y
RETARY
TO GOVERNMENT,
J
|
I
*1
ANNEXURE - I
ORGANISATIONAL SET UP Op
HEALTH AND FAMILY WELFARE
P^'RTMENT
SECRETARIAT LEVEL:
MINISTER OF HEALTH AND FAMILY WELFARE
GOVERNMENT OF KARNATAKA
I
‘ J/
deputy secretary
■
r
UNDER
SECRETARY
SERVICES
(health)
r
UNDER
SECRETARY
C&R
UNDER
SECRETARY
HEALTH
UNDER
SECRETARY
R & I
UNDER
SECRETARY
I.S.M.
I .
1
UNDER
SECRETARY
LEGAL CELL
I.
I
I
I
1
ANNEXURE-II
SECRETARY TO GOVERNMENT
HEALTH AND FAMILY WELFARE DEPARTMENT
DIRECTOR
I.S.M.
DRUGS
CONTROLLER
COMMISSIONER FOR
■ HEALTH AND FAMILY
WELFARE
I
director
STATE INSTITUTE
" OF HEALTH AND F.W.
PROJECT DIRECTOR
IPP-IX(K)
I o
"TO 0)0irf •
DIRECTOR
HEALTH AND FAMILY WELFARE
SERVICES
PROJECT ADMINISTRATOR
CUM E/o SPL.SECRETARY
TO GOVERNMENT,
'
!
f)
8
ANNEXURE-III
ORGANISATIONAL SET UP OF HEALTH
FAMILY WELFARE DEPARTMENT
DIRECTORATE LEVEL:
COMMISSIONER FOR HEALTH
DIRECTOR FOR HEALTH AND FAMILY WELFARE SERVICES
’•
? J
PROJECT DIRECTOR
RCH
r n I
DEMO
GRA
PHER
JOINT
J.D.
PROJECT IE.C.
DIRECTOR
' (ROK)
J
1
I
IT
ADDL .DIRECTOR
CMD
J.Ds.(9)
1
2)M & F
1 I
■
A.O.
A.O. J.D.(CMD)
(ACCOUNTS) (TRANS
PORT)
1)H & P
4
STATE SURVELLANCE UNIT
3) T.3.
4) LEPROSY
FTT
“T
DY.DIRECTC
(TRANSPORT
ADDL.DIRECTOR
HET
A.O.
JOINT DIRECTOR
HET
S)P.H.I.
6) VACCINE
INSTITUTE
BELGUM
7)OPTHALMOLOGY
8)MEDICAL
_9)G.M.S.
DY.DIRECTOR
SCHOOL HEALTH
EDUCATION
1
II
D.N.O.
TRAIN
TECHNICAL
ING
. OFFICERS(3)
OFFICER
ANNEXURE-IV
divisional level
director of HEALTH AND
FAMILY ’'•'EL FA RE SERVICES
DIVISIONAL JOINT DIRECTOR
DY.DIRECTOR
(HEADQUARTER)
GAZETTED
assistant
dy.director
NMEP1 zone
HEALTH OFFICER
SSA UNIT (LEP).
£-- —
---------------------- ---
MEDICAL OFFICER
MOBILE OPTHALMIC
OEM DENTAL UNIT
(SCHOOL HEALTH)
sueoEON(LRPu:
disttIurgeon /
SUPERINTENDEDENT
DIST.HOSPITAL7
I
I
I
ANNEXURE-VI
BLOCK LEVEL (BELOW TALUKA LEVEL)
MEDICAL OFFICER
PRIMARY HEALTH CENTRE
r
□LOCK HEALTH
EDUCATORS (BHE)
SENIOR HEALTH
ASSISTANT (MALE)
SENIOR HEALTH
ASSISTANT(FEMALE)
JUNIOR HEALTH
ASSISTANT (MALE)
JUNIOR HEALTH
ASSISTANT(FEMALE)
LAR. TECH
NICIAN
) ’
FIRST DIVISION
ASSISTANT
r
COMPUTER
PHARMACIST
ANNEXURE-III
t
I
ORGANISATIONAL SET UP OF HEALTH
■ • I
FAMILY WELFARE DEPARTMENT
COMMISSIONER^ FOR HEALTH
DIRECTORATE LEVEL:
DIRECTOR FOR HEALTH AND FAMILY WELFARE SERVICES
V
PROJECT DIRECTOR
RCH
ADDL.DIRECTOR
CMD
J.Ds.(9)
1)H & P
ADDL.DIRECTOR
HET
4)LEPROSY
DEMO
GRA
PHER
JOINT
JTD.
PROqECT IE .C .
DIRECTOR
(RCH)
’J
A.0.
A.O. J,D.(CMD)
(ACCOUNTS)(TRANS
PORT)
STATE SURVELLANCE UNIT
4/
DY.DIRECTOR
(TRANSPORT)
F.A.
A.O.
2)M & F
3)T.B.
xj
4/
C.A-O. C.A.O.
I
CUM
JOINT DIRECTOR
HET
5)P.H.I.
6) VACCINE
INSTITUTE
BELGUM
7)OPTHALMOLOGY
8)MEDICAL
9)G.M.S.
DY.DIRECTOR
SCHOOL HEALTH
EDUCATION
TRAIN D.N.O.
ING
OFFICER
TECHNICAL
OFFICERS(3)
ANNEXURE-IV
A
V
DIVISIONAL .L5~vTl
director of health AND FAMILY
WELFARE SERVICES
divisionalLoint
director
--L-
I
dy.director
(headquarter)
GAZETTED
assistant
DY.DIRECTOR
NMEP ZONE
HEALTH OFFICER
SSA UNIT (LEP) .
faE?Health and
•
family welfare department
medical officer
OPTHALMIC
CEM DENTAL UNIT
(SCHOOL HEALTH)
mobile
SU3GcON(LRPU)
~ disttIurgeon /
SUPER INTENDEDENT
—PI SILHOSPITAL
ANNEXURE-VI
BLOCK LEVEL (BELOW TALUKA LEVEL)
MEDICAL -OFFICER
PRIMARY HEALTH CENTRE
F ~
BLOCK .HEALTH
EDUCATORS (SHE)
SENIOR HEALTH
ASSISTANT (MALE)
" I
JUNIOR HEALTH
SENIOR HEALTH
ASSISTANT(FEMALE)
■ JUNIOR HEALTH
ASSISTANT (MALE)-- ASSISTANT(FEMALE)
LA3. TECH
NICIAN
FIRST DIVISION
ASSISTANT
PHARHASIST
Jz
COMPUTER
>I
3
1 3
J
>
r
Overview of
Karnataka Health Systems Development Project
5
- Dr. G.V. Vijavalakslinu"
4
)
Karnataka Health Servi
'“s pravi<ie a"
India at three levels namely
in the sta,e „ etavhere
1. Primary
)
)
Secondary &
3. Tertiary.
j
own funding and also
resources [llrou^ 'he State s
tertiary Hospitals are fairly well develone/in kn
vari°us IPP projects. So also the
m the State with their attached Hospitals are b™ua 'ayith more than 19 Medical Colleges
secondary level of heath care hitherto neglected so'?
f°r C1‘nical facilities. Whereas
Of
.He world Bank
n„w Hy .He Goo
Projec. alms at improving the infrilsmctl,r(. an;1
" ’k" “«■ Systems Develop merit
serrmes by .He seeondaty ievei Hospna.s based in mra! are^of .be SjaZ SmV
care
The Secondary Level Hospitals are of various tvnes
.
disparity in the availability of infrastiucture and the qualify of
ma=n,tude Wlth marked
hospitals and it varies in different areas of the Sra-A
u Y f ;,ervices Provided by these
the Secondary Hospitals which is only an organic extension of fhe of
netW°r!< °f
Secondary Health Care is now being recognised all oZ th °f th" PnmarT health care system
Systems Development Project 1 &"state^Health <s
world and thus the State Health
existence. State Health Systems Develoomen PrStT DeveloPment- P^ct 2 came into
State Health Systems Development Project 9 covenKa
State and
in India.
P
J6Ct ~ C°V £rS karna'aka Punjab & West Bengal States
KHBDPccovers 201 rural Hospitals 107 of which
are subdivisions! Hospitals and '4
i 4 divisions of Karnatak
are Community Hospitals or CHCs in
which is covered under
'
karnatak,a except the Gulbarga Division
- - kfw' project.
Land Marks
1. Pre Project Activities
2. Preliminary' Project / Project Plan
3. Workshop
• Project Preparation Committee
• Norms for Hospital facilities & Services
• High level Committee
MD. F.I.C.S..
Consultant. KHSDP. Bangalore
Dec 1994.
Jan 1995
-S'"1 Feb ! 995 to r1 March 1995
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 &, FW Services and other various Additional & Joint Directors of the department
Establishing Norms for Hospital Facilities & Services Committee was formed by various
working groups namely,
1. Medical
2. Surgical
3. Diagnostic Groups
Medical Group was comprised of
a) Physicians - HODs of Medical Colleges and leading Physicians of Private sector
b) Cardiologists from Jayadeva Institute of Cardiology, Bangalore
c) Neuro Physicians & Psychiatrists from premier Institutes
d) Paediatritians from Medical College Hospitals.
e) Forensic Medicine experts
0 Experts in Preventive Medicine
g) District Surgeons
h) Physiotherapists. •
i) Chief Nursing faculties.
Surreal ^’■oup formed a huge working setup headed by a clinical expert with wide Hospital
experience and Administrative Officer supported by
a) General Surgeons
b) Obstetricians & Gynaecologists
c) Orthopaedic Surgeons
d) ENT Surgeons
e) Ophthalmic Surgeons
f) Dental Surgeons
g) Anaesthesiologist
It also included Super Specialists like
a) Urologists
b) Thoracic Surgeons &
c) Neuro Surgeons &
d) Representatives from Op eration Theatre Nursing and Nursing Superintendents
Apart from this it included
a) Bio-Medical Engineers,
b) Health Equipment Specialists &
c) Training experts from ASCI, Hyderabad
l^nnnostic (Innip whidi included
■>) Pathologists & Bacteriolomst.s
b) Radiologists^ Sonologists
c) Bio-C heniists
d) Micro Biologists
e) Laboratory service Experts
f) Senior Technicians &
g) Nursing Assistants from Govt. & Private sectors.
.. Simultaneously different Sub-Committees with
'
Hosnitals Af H H,
h Var'0US disciP,ines were formed and the
learns visited various Hospitals
for RTNA
rtva study (Rap.d
hospitals of
of different
different categories
categor.es in
m the
the State
State for
Training Need Assessment Tko ,
j- □
e fop RTNA
° Assessment).
The teams studied the requirements
Nonclinical, Diagnostics
PharmLists^Hosnita'lM
reqU'^ments for
tbr t '
Clinical,
aspects.'.Through
the workshop there were observers from the WorW sX'nd Training
Offic"3 aSpeCtS
Thr0U=h <0111
andd Ofticer
Officerss from other States of
Punjab & West Bengal.
AJI the Committees submitted their report to the Govt.
Thus the final Project Proposal of KHSDP
was submitted to the World Bank iin
bept 1995.
Minister of India^lr.H.DXt1^^^^
P^ecc XZX*
" eXtenSiVe W°rkSh0P
3 dayS °n -riouT aspect™t
I ■ Health Secretaries from Govt of India,
2. Health Secretaries from 3 States of Karnataka, Punjab & West Bengal &
Hea.rh SeCraai7 from Andhra Pradesh ,o guide ,|,e junior p“ °“’“i &
n. ra eep Pur,. IAS, Project Administrator ofKHSDP & el„ Secretary to Gov,..
Heahh
project activities in various phases
°fD~ »'■
Q'scuss the implementation of the
Salutations and renu'tnhrances to l.',^
the following Officers & Officials who worked for
Pre Project activities & preparation of Project Propostd
I- Mr.Gautham Basu, Health Secretary to Govt of Karnataka
Additional Secret^ to Govt o^X
u. Mr.D.V.N Sharma of STEM, Govt, of Karnataka
4. Innumerable Officers of various cadres of Clinical,
Administration, Statistical
sections of Health Dept.
J
[S'.
Implementation of the Karnataka Health Systems Development Project (KHSDP)
KHSDP ollice has been established in the premises of Public Health Institute Buildme
on Seshadri road. KR. Circle, Bangalore-1.
To insert Sri. B Eswarappa. IAS. Secretary to Govt Health' F& ”Family Wei I are
Dept Project Administrator & E/O. Add.tional Secretary to the Govt, of Karnataka.
OfFmer ChTm3'
the
PrOjeCt team He is assisted bY Chief Administrative
Officer, Chief Financial Officer, Under Secretary, etc., with their respective teams.
of Ho
Bi°:Medical Sneering consultants provide technical assistance in procurement
of Hospital equipment and Training programme for the technical assistants for reoair &
maintenance of equipment through out the State.
Enginee^rExlmive'F’'^'1
''a Ch'ef En=,neecr and assisted by his team of Superintendent
E"s“"s' A“' E"8i"""' J“'“
JSJ SX S3
Deputy Chief Architect heads the team of Architects in
preparation of plans, etc., for
construction of Hospital Buildings with technical emphasis.
Medical Wing constitute of
'■ ^olverHeSST'^^3'6810
research stud.es
Cell)
C00rd‘nateS
by his tMm & consultant wh°
p,ann'n= and
2 flint oTreLorTV (Mnedica,)'S.SUpporled by
Project Consultant and a team of
°0 hJso Ts ™aUr1
PUty D'reCtOrS.tO '°0k after a11 aspects of infrastructure of
Equi^mstZ^^PaCe n°rmS 10 PlaU8’ °PeratiOn Ti— d^" a"d
GmSDutvT I6"'
skills
trainirprOyramme which includes clinical training for
Spec.ahsts in various disciplines to upgrade their clfnical
a'
fOr TraineJl of Traine=s(TOT) or Master Trainers bv the
J1PMER, Pondtcherry team and St. John’s Hospital, Bangalore
b. Set1 Hospitals"^ °fthe TalUka leVe' H°SP,talS and'CHCs
the T0Ts 'n
c. Specialists’ training at super speciality Hospitals under taken at
i. Jayadeva Institute of Cardiology
ii. Indira Gandhi Institute of Child Health
in. Trauma Care training at HOSMAT & Mallya Hospitals
iv. Neurology, Neuro Surgery & Psychiatry at NIMHANS
V. Laparoscopy & Foetal Monitor Tocography at MS Ramaiah Medical
College Hospital & Vam Vilas Hospital, Bangalore.
The training programmes will be further extended in other premier instiiutes for
various other disciplines.
Stall Nurses training is undertaken at major District level Hospitals in Govt and
private sector through out the stale
.Pharmacists training starts with stale level training with the trainers from 20-1 2-i •)97
bv
of
all over
. Laboratory Technicians’ training in Bacteriological & Chemical analysis of Water is
conducted at Public Health Institute. Bangalore.
!*•
!
V. Karnataka Health Systems Development Project (KHSDP)
Status as on March 31, 1999
Basic Data:
E
I
I
i
Title
Second State Health Systems Development Project (K)
under IDA (WB)
Credit No.
Cr. 2833-IN
Date of
efTectiveness
Date of closing
(original)
06-27-1996
Loan Amount
Rs. 54,58.01 Million for Karnataka Component
Project Objectives
1. Improve efficiency in the allocation and care of health resources
through policy and institutional development
2. Improve programme of the health care system through
improvements in the quality, effectivemess and course of health
services at the first referral card and selective course at the poverty
level to better serve the neediest section of the society.
03-31-2002
The Second health systems Development Project is being implemented in three states
namely Karnataka, Punjab and West Bengal. This project is assisted by International
Development Association (The World Bank). The total project cost is to the tune of Rs. 16,691.4
million, of which the share of Karnataka is Rs. 5,458.0 Million spread over a period of 6 years
from 1996 to 2002.
The Project components aim at improving sendee and clinical effectiveness at district,
sub-division and community level hospitals under the project. 74 Community hospitals, 104 subdivisional hospitals and 21 district hospitals are renovated and extended. With the result 3832
new beds will be added to the existing bed strength of 5822 at first referral level. The project aims
at providing better access to health care to the Schedule Caste and Schedule Tribe population of
the state and also for women.
!
J.
General overview: The KHSDP became effective on June 27, 1996. The project
could not make considerable financial progress during the year 1996-97 as there was not much of
preparation. However, during the year 1997-98, as all the preparatory activities were completed
and the project has been making a steady progress. The project activities have been reviewed by
the World Bank Supervision Missions during March 1997, November 1997, May 1998 and
November 1998
19
QbJL-IS5-99
=r
HcLitalTshoutd have bel^taken 270^0™"!’ ren°dVa:iUn and
expansion of 201 KHSDP
avoid cost escalation on civil works a deci\ P 3563 T118
y6arS 1997’2000 In order to
the approval of the World Bank to initiate l0? WaS taksn by Project Governing Board with
aclunt of this decision, it is expected tharoh' W° i 5 'V”
hospitals simultaneously. On
could be assigned by June 1999 after ^h ^
T /T 5 f°r aH the 201 KHSDP hosPitals
and World Bank procedures.
obser™g all the formalities relating to Bidding process
empanelled.
hospital works. 134 hoTpital work'h
K
™rtS' 46 Architects have been
T? by W°rld Bank Architect
’S3
works are taken up under Force Accoum InkdZ
T eVa‘UatiOn °f bldS Under NCB 6
have been prepared and approved for 167 h
° 1 S’ estimates and detailed drawings
completion of Work an EnZerin^ w63 h°Spital WOrks' In order to facilitate speedy
Engineers and 6 divisions is already functSng.^1 3
En§ineer’ two Superintending
98-99
p,“for year 98
-” is approved by
procured for the hospitals7Zded 7X777777
be
third
phases.' The
The Procurement of some
medical equipment like X-rays and Dental
P and
■ fourth phaS£S
the installation of these7quiPmem
P°Stponed t0 the next year issued and b.ds covered b^h^e two jfis are0" TX0
NCB arC a,ready
of 14 equipment, Notification of AwaH
7"? Xevaluatlon in progress. In respect
Committee. As approved by the World n 7 n 77 made 33 aPProved by the Steering
procurement of Ultrasound Scanner. -tlX
7
ICB ’S 'SSUed On 16-3-1999 for
X-ray and Blood Gas Analvser. I W' W° probes’ Portable Ultrasound Scanners, Dental
revised
and are being sent to the Wodd^Bankfor their^Objepdon. SpeCiflCati°nS haV£ been
revised and
i'
Competitive Bidding pXss'"l 80 TATA s’ TX1]6
1997'98’ under Inte™ational
-Medill Officers District Su^eonJ d n
° e
C'eS W6re Procured.and given to Taluk
Maintenance Vehicles were nmc d ?StnCt SurVelIlance Uni^ Similarly, 21 Equipment
Centres. The IFB under ICB 7as Tsledfo
?Jtr‘Ct Equipment Maintenance
and with the approval of Proiect Co
■ F P'’ocu''ement of Ambulances, bids were evaluated
Notification of Award is mvl toffi
N° ObjeCti°n fr°m the WorId Bank,
§
For the procurement of 62 addition!
procurement °f 116 Ambulances.
Surgeons of the newlv for d nPS ■ ° etglVen t0 the Taluk Medical Officers and the
District Surgi
geons ot the newly formed D.stncts, the IFB under ICB is issued on 16-3-1999.
,he tn98-”
xx
being procured under National Cn
n
10 G rnon,h
May 1998. The drugs are
•he No.iSc.ion, The bid, were opeX'o'n 29
inC'“ded
orders are already placed with hinZ a
• 9.8" 9?8 and evaluation is completed. Supply
rs after signing of contract for supply of these medicines.
•1
II
■J
J
20
QNL-IS5-99
J
,3
1
I
i
5. Local Training: So far 1101 Doctors have been trained in different specialities as part of th
programme. Further to develop resource persons, trainers training programme was organist
with the support of JIPMER from Pondicherry and so far 40 Master Trainers (Doctors) ha'
been trained. At District Level, 464 Doctors have been given training. The number of Nurs
trained under General Nursing so far is 1693. Under the specialists Nurses Training in ti
field of Paediatrics, ICCU, Neuro Nursing and Psychiatric nursing, so far 302 nurses ha\
been trained at NIMHANS, Indira Gandhi Institute of Child Health and Jayadeva Institute ■
Cardiology, Bangalore. Similarly 15 Laboratory Technicians have been trained. As part of tl
Equipment Maintenance, 38 technicians have been trained in two batches at ATI-EP
Hyderabad. In addition to that a four weeks training programme was organised for the:
technicians to give training on equipment which have been procured under the project. Tl
training was imparted by the suppliers who have supplied equipment. Further the specialists
the field of Paediatrics, Orthopaedics, ICCU, Laproscopy and Feotal Monitor, Neurolog
Neurosurgery, Psychiatry and Mental Health and Dental have been trained at Indira Gand
Institute of Child Health, Sanjay Gandhi Hospital, Bangalore and Jayadeva Institute <
Cardiology. So far 446 Doctors have been trained in these specialities. The Doctors workir
in Community Health Centres and Taluk Level Hospitals are being given training
Administrative Procedures. So far 109 Doctors are trained in Administrative Procedure
Similarly an induction training programme is being conducted for newly recruited Doctors t
give them basic exposure in various aspects of administration and also to sensitise them t
Karnataka Health Systems Development Project activities. So far 209 Doctors have bee
trained in Induction Training. 28 Chief Pharmacists / Graduate Pharmacists have been traine
in Pharmacy Key Trainer’s Training.
6.
M/s. STEM Consultants are assisting the project for the Project Management and M/s. VI
Murali & Co. are assisting the project for Financial Management and accounting system.
7.
Reimbursement of Claims : Further, Karnataka has claimed 111.8 million as retroacth
finance admissible as per project and credit agreement, for the period covering 1-5-1995 t
27-6-1996. Expenditure incurred during 1997-98 is Rs. 622 Million against the budg
provision of Rs. 700 Million. The expenditure eligible for the reimbursement for the peric
ending 31 March, 1999 (Provisional) is Rs. 1619.28 (1NR in Millions). The revised estimat
for the year 1998-99 is Rs. 1,34,55,00,000/-. As against this, upto the end of March 31, 199S
an amount of P<s. 920.55 Million (provisional) is spent.
E
I
0
t
r
I
f!
h•
21
QN'L-ISS-
VI KfW PROJECT
STATUS RJ-PORT ON KflVPROJECT AS ON MARCH31,1999
C-.lh The 5^ assisted German project covers 51 hospitals i
in the Revenue Division of
hospital' EvC Th""6 ST" is pro8rammed t0 be completed in
two phases covering these 51
project, the signingTf
agVe^StTnd’fi etC ’
COmpleted on Par with ^e KHSDP
a£reement °f KfW assisted project was
delayed. On 16-1-1997 the nroiect ao-
SAN1PLAN Group froXX X L rn
the Consultants ™e
Consultants and STEM. The planning workshonCfnSU tai|tS aSS‘Stcd by V*'eidel Plan
Medi
Guibarga on 3-11-1997 and 4-11 1997 in th- P i°r lmpIeraentatl0n of KfW Project was held at
Welfare, Director State Institute of H li
P T™8 workshoP’ Secretary, Health & Family
representatives of Bidar Guibarga and Raich
^elfare’ The Chlef Executive Officers/their
Officers of the four districts of Culba
Ther^istnct Surgeons and The District Health
hospitals covered by first phase the Pm^
^e Administrative Medical Officers of 26
Project and the Consultants of the KfW Proiec^
Kamataka Health Systems Development
were held regarding preparatio f
Project participated. In this Workshop, deliberations
discussed at the time of workshop
Van,°US comPonents of the project works. As
finalised and the consultants agreed f P
nOrmS Hnd circi-dat>on pattern for the hospitals were
Supervision Team Z“si.edThe s,'^‘ T*;
The KfW
satisfaction in the progress made in • 1
arnataka on 15-7-1998 have expressed their
up under Km,taka He.hh Systems Deve“fPtojeeffo
DmST
'’k“
.he emp»efe7p7vt°e"SS^‘l “'T8’ f" ''
cleared^ preX
of 26 h°sP^
°f S^LAN d“™8
dlXi rl
eutnrs.ed .o
™its h’s
changes in the preliminarv’dmS
t ^chjt*cts have been requested to. incorporate the minor
hospitals, the preliminaX dmXtS
‘ i^ Tt0
for cIearance- In resp^
3
problem is solved, the prelimmar^dZ™ '
Pr°b,emS As soon the site
these hospitals win commence in Maw^jw
‘k””1
'“s,njctit’n work in
°f
■hat .he^Xem wHch to «" “T"0"
“1' n’0",h °f ,“l>' ,998. " »“ d-ussed
hospitals covered by the first phase TH^ &
procured and suPPhed to the
have been initiated The Bidding D.
T
t0 and the P^ement process
the procurement of medical and
SP\clficatl^s are already approved by KfW. For
NCB ire finalised and .he KfW have gk'e’XrMce
»*r ICB and
procured and given to the oftoels oftheS'lVV-rT"' °.n'“'S, <s“ v'hi'les) “re being
by the KfW Authorities.
JeCt T ie purchase of these 6 vehicles is cleared
22
QNI>-IS5-99
I
r
I
t
The KfW has deposited 500000 DM (Rs. 1.5 Crores) in the disposition fund for initiatin'
pTnecr icuv'ces. Fie office cri AJonurmf Dtffiurcr .hn? surx-T fumumng: FTe
oi
Executive Engineer and Accounts Officer have been created. The posts of Accounts Officer and
Assistant Executive Engineer are filled up. The post of Executive Engineer is vacant.
The software activities of this project are on the lines of Karnataka Health Systems
Development Project and are funded under the World Bank project. In line with this, action has
already been taken to provide vehicles to the Taluka Medical Officers. Training of Doctors anc
nurses has already commenced. Vacancies of nurses are filled up in the KfW assisted hospitals.
The training curriculum and protocols have been prepared. The yellow card scheme, a scheme
intended for providing better access to health care to the Scheduled Caste and Scheduled Tribe
population has already been initiated. Apart from the Karnataka Health Systems Development
Project activities the construction of Rajiv Gandhi Memorial Hospital at Raichur is going on as
scheduled. Nearly 75% of the construction has been completed and the project would be
completed within December 1998 as scheduled.
S
$
i
£
*
In the first phase of the project as detailed in the financial agreement, the breakup of each
component is as follows:
Measures
-
I
L
i
p
!>
£
Rehabilitation of Secondary Level Health
Institutions_____________________________
a) Construction__________________________
b) Medical Equipment, Medicines___________
c) Vehicles____________________ _________
Rehabilitation of two district hospitals_____
Maintenance facilities___________________
Waste Disposal facilities__________________
Management-Information-System and
Surveillance____________________________
SC/ST Women__________________________
Project Management____________________
a) Consultant Service
_________________
b) Fees for design_______
c) PMC________________________________
Price and Physical Contingencies__________
Price Contingencies______________________
Physical Contingencies____________________
Total
Total Cost
(Rs. Million)
277.20
154.00
114.40
8.80
24.20
33.00
19.80
4.40
17,60
96.80
33.00
13.20
50.60
118.80
52.80
66.00
591.80
IL
t!
23
QNI/-IS5-9
Referral System
Dr G V Vijayalakshmi
Consultant, KHSDP,
Bangalore.
What is a well functioning Referral System ?
It is a mechanism where patient with complex health problems are identified
on time and treated
promptly at an appropriate health care facility.
I'
quality medicare
if
I
can be provided only when a
ii
'■
I
proper and effective referral system is formulated and!
_______
implemented
j
Health Care Delivery System :
•
Primary Care Services
Secondary Care Services or First Referral Services
•
Tertiary Care Services
•
70% of the population Live in Rural Areas.
•
40% of the population are below poverty line.
.■ )sS
taZSX Z" B»%,( M44%
(Femtei> “
S>“
+ 7 (New ) Districts.
MySOre’ GulbarSa and Belgaum and has 20 ( Old
hospitals status
Primary Health Units
= 621
Primary Health Centres = 1601
CHCs with 30 Beds
CHCs with 50 Beds
= 71
70
Taluk Level Hospitals > 50 < 100 Beds
= 27
Sub-Division Level Hospital with 100 Beds = 12
District Hospital with > 100 Beds
= 19
5
CHCS WILL BECOME THE FIRST REFERRAL UNITS FOI
PRIMARY HEALTH CARE
STRENGTHENING MEASURES :
’
1.
Use of Referral cum Feedback cards.
2.
Implementing Referral Guidelines.
Establishing an incentive system.
4.
Linkages and communication through training.
5.
Developing EEC.
6.
Bringing under perview of District Level Health System Committees by forming
District Referral Sub-committee.
CURRENT REFERRAL SYSTEM :
No definite system is existing
•
PHCs
- Inadequate quality of services.
CHCs
- are often bypassed
Tertiary
- are unnecessarily overburdened.
1/3 population seen in OPD’s of all Hospitals on an average suffer from simple ailments. The
reasons are :
•
Patients self referring to higher level hospitals
•
No confidence
• No proper linkage
No guidelines
• No written conventions
No prioritisation
• Mismatch of Specialists
Duplication - investigations & treatment
MAIN OBJECTIVES OF THE REFERRAL SYSTEM :
> Increasing community accessibility
\ > Developing linkage through a referral system.
i > Higher tier providing technical leadership & support to lower levels
DETAILED OBJECTIVES :
Timely identification.
>
Referring needy patients to higher facilities.
> Community developing confidence.
> Creating awareness in health workers.
Appraising patients about incentives for participating in the referral system
INCENTIVES FOR REFERRED PATIENTS :
Referred patients are also Eligible for similar concessions as per Government Order in the
Low Income Groups and any special concession in Dire Emergencies for the poor and needy.
•
Report directly
•
No separate outpatient slips
•
Providing food
•
Providing ambulance
TECHNICAL SUPPORT TO PRIMARY LEVEL :
•
Strengthening Primary Care programmes
•
Periodic consultant services
•
Doctors & Paramedical Training
EEC
Health Care System
NGOs as opinion leaders
Patients using health facilities
Awareness of facility
SC / ST be aware of Primary health care
Various media yvill be :
•
Health workers used as educators
•
Door to Door campaign
•
Pamphlets and good sign boards & Maps showing Referral Chains.
b
Referral Network
a) Zoning
b) Referral Chain
c) Referral Maps
I
II
Facilities for transportation of Patients
I
I
I
III
4
Operationalisation
of the Referral System
ES ’ ^a) Pllot chitradurga District Hospital
(b) Udupi District Hospital .
Groups
1
2
9
•
This is a 100 bedded hospital
Bed occupation rate > 75%
•
Hospital is clean & tidy.
training programme
Participants
Training
Institution
Duration
Trainer
P JrHeahhAssts. ofsubce^T^T
2 Nursing Personnel of PHCs & chcz^t One day Senior Staff Nurse
TH.
CHCs
and other paramedics
1 Medical Officers of PHCs &
CHC Level One day
PHU
Administrative
2. Medical Officers of CHCs
Medical Officer TH
3
4
5
6
7
Nursing personnel of T.H.,
Sub-district Hospital & D.H.
and medical social workers.
2- Paramedical & Administrative
Staff
1 Medical Officers of TH
S.D.H, D.H, DHO & District
Medical Officers,
1 • Patients in wards
2. Visitors
1 • Anganawadi workers
2- Other NGOs
One day
Senior Staff Nurse TH
District
Hospital
One day
Nursing
Superintendent DH
District
Hospital
One day
District Surgeon
One day
Nurse I/C of
ward/PHC, BHE
One day
Junior Health
Assistants
GOALS OF TRAINING PROGRAMME
Defining the problem
Effective referral chain
•
Feedback & support
•
Initiating co-ordination
•
Establishing role of health unit
The Training target includes
1. Hospital
- Doctors nurses & para medicals.
2. Non-Hospital staff
General workers using the facilities directly
or indirectly.
3. Patients and visitors
4. Socially active groups
- Women groups, NGOs.
5. Administrators of key institutions.
Heads of schools.
- Zilla / Taluka Parishat members
PREPARATION FOR IMPLEMENTATION OF REFERRAL SYSTEM :
1.
Referral cum Feedback card
2.
Referral Guidelines
•
Administrative guidelines for Referring Health facility
(a) Referral flow chart
(b) Zonal System & maps
(c) Higher health facility
(d) Check patients before referring by MO
(e) Adequate supply of drugs
(f)
Transport
Administrative guidelines for Referral Hospital :
(a) Improved space norms.
(b) Upgrading & Updating clinical skills of MOH by Training regarding Service Matrix.
(c) Receive the referred patient
(d) No queue.
.•i
■ft
(e) No delay.
(0 Top priority for critically ill,
J
women & children.
(g) Out patient Referrals disposed off the
same day.
(h) Referral register.
(■)
Diet.
G)
Fax / telephone.
■s
(k) X-ray, Lab tests.
0)
Handling for 24 hours.
(m) Referral Task Force.
(n) Non-governmental health institutions.
Referral Protocols
(a)
■”
Types of conditions
'(b)
When and how to refer
(c)
Advising the patient
(d)
Emergency Protocol services
ORGANISATION:
-
•
State Level
•
District Level
(a)
Identify Referral Zones & Chains
(b)
Monitoring
(c)
Mobihsing transport
(d)
Coordinating technical support
(e)
Making necessary infrastructure
(f)
(g)
•;
-
Training health staff
Developing EC program
Taluka Level
i (a) Implementation, monitoring & servicing
j (t>) Technical support
! (c) Training health personnel
(d) IEC strategies.
3c
CONCLUDING REMARKS
•
Overall responsibility
•
Funds (KHSDP)
•
District Referral Committee - Monitors the progress.
Referral Training Programme
Not Passing the Buck
Referral System is only a Tool to Provide best Medicare
and
Not Shirk Responsibilities
Critically ill Patients / emergencies are
attended Round the Clock
Ji
lJ—
zJL
r,
/) ^3 .
F\ - 3-^-^
a
S>-
r7
I 0x0/ —
r
.0^3^
f
L
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'11
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7
K C
J
S'
Referral Card
Name of the Referring Hospital:
Name of the Patient :
Reen. No. :
Address :
A«e :
Date :
Time :
'Sex :
Clinical Diagnosis (Provisional)
Name of the referred Hospital:
Purpose of referral : Investigation / Consultation
/ Surgery
Data by referring Medical officer :
(Examination conducted, investigations carried
time)16^6111 S1V6n and conditlon of Patient and
Signature and designation of
referring Medical officer /
Specialist
Remarks of receiving Medical Officer /
specialist of the Referred Hospital
Signature and Designation
of receiving Medical officer
oi the Referred Hospital
Date :
^-1
Time :
1
Feed Back Information
Name of the Hospital :
Name of the Patient:
Regn. No. :
Address :
Date :
Time :
Date :
Time :
i Age :
Sex :
Final diagnosis / investigation
I treatment provided
Remarks of the Medical Officer / :
Specialist attending the case
(including follow - up advice )
Signature of the receiving Doctor
Designation :
I .
Follow- up Notes :
.......
'f 7
■ tv
r
_>
ECTOPIC PREGNANCY
CLINICAL SUSPICION
OF ECTOPIC
GESTATION
Measure
HCG
r
3
- ve
+ ve
Ultrasound
not available
ultrasound
P-XZ
Gestational
sac in
LuTERUS
Gestational
- sac in
TUBE
Doubtful
_________ ▼
Ectopic
Gestation <
Ruled Out
!■
LAPAROTOMY oil [ laparoscopy
laparoscopy
and Treatment
J LAPAROSCOPY~|
or LAPAROTOMY |
3^
PROTOCOL FOR MANAGEMENT OF ECTOPIC PREGNANCY
Ruptured Ectopic
Unruptured Ectopic
Short period of Amenorrhoea (+/-)
Attacks of Lowr Abdominal Colicks
+ Spotting of Blood P.V.
Black outs
Sub Acute or Chronic
Symptoms become Chronic
Dull achmg plin
Difficult in defecation
Gentle Pelvic examination
Tender mass in adnexal
region
Tender Cervical movement
Hypochromic Anaemia
Pain & Bleeding reduces
by rest
Ultrasound (U/S)
Laparoscopy
Unne - b HCG
Start I.V. (Saline or Blood
Substitute)
Arrange for blood
B.T., C.T., + B%
Laparoscopic
management
LAPAROTOMY
^Conservative Surgery
Salpingectomy
Milcking out products
Linear Salpingostomy
Resection of Tube & end
to end Anastamosis
<•
Acute Rupture
Patient in shock
Pollar Disproportionate
to external bleeding
Tenderness, Rigidity &
Fullness in Labd.
Auto Transfusion
(5 part blood + 1 part
citrate solution = 3.8%)
I
nOW CHART SHOWING REFERRAL ZONES AND
CHAIN IN A DISTRICT
f
Level
?
?
Subcentre |
I
PHC
PHC
[Subcentre ]
[~7h?~| |~phc~~|
II
CHC
III
chc
n
Sub District Hospital
|
V
District Hospital
]
____ V
Tertiary Hospital
4
ri
PHC
CHC
I
Taluk Hospital
IV
VI
xz
PHC
___
i
FLOW CHART SHOWING REFERRAL ZONES AND CHAIN FOR UDUPI TALUK
Level
PHC
I
Kolalgirl
Malpe
Korkehalll
Mudalbetta
Hirebetta
Manlpura
Kappu
Kammennu
Barkoor
Kokarnl
Pelhri
Sasthane
Saiberkatte
Avarse
Sallgrama
Kota
Kadibangra
1
13
34
6
25
8
30
II
v
DISTRICT
HOSPITAL
TERTIARY
HOSPITAL
33
12
18
V.
-- SHIRVA
UDUPI
40
VI
Padubldre
38
12
SUB
DISTRICT
HOSPITAL
15
BRAMHAVARA
CMC
IV
5
Mudarangadi
Hireyadka
WENLOCK HOSPITAL, MANGALORE
4I
LADY GOSHAN HOSPITAL, MANGALORE
II
r
FLOW CHART SHOWING
Level
I
phc
’I
I
II
REFERRAL ZONES AND
pravalhur; Donde
—Rangadl
BajegolFl \
7
19
taluk
hospital
11
Bailor
Belrnanu j
Paladka
V
CHC
13
hebri
III
Palli
CHAIN FOR KARKALA TALUK
9
nitte
.22
11
sub
district
hospital
38
V
district
hospital
UDUPI
0
VI
NOTE :
□ .
TERTIARY
hospital
X
mudabidre
KARKALA
IV
10
Kallamundkui (
4(T
I Sajjaripete
'22
Nellikaru
18
FLOW CHART SHOVVING
REFERRAL ZONES AND CHAIN
FOR KUNDAPURA TALUK
Level
I
phc
Alur
Vandse
Kolluru
Shirur
3
Bidakalkatte J
Bindoor
16
II
Pshankaranarayana |
Kumbashi
Heladi
Gangoli
Kirimanjeshwara
Barkoor
Belwe
24
28
SIDDAPURA
8
III
IV
26
'6
8
CHC
Nada
v
TALUK
HOSPITAL
KUNDAPURA
26
]■
sub
district
38
HOSPITAL
Ln
I
V
V
DISTRICT
HOSPITAL
UDUPI
40
VI
TERTIARY
HOSPITAL
WENLOCK HOSPITAL, MANGALORE~[
LADY GOSHAN HOSPITAL, MANGALORE
NOTE : Numbers on direction arrows represent distance in kms.
»
Anncxure
Monthly Report on Referrals
To be submitted by each Referring Uni
~ nit to the immediate higher Referral Unit by 5,h of the following month :
Staff not available during
the month
A
1
2
3
Category
Specialists
No.
I
No. of Patients Referred
Adults
Male Female
Children
Male Female
Total
Grand Total
I
B GDMO
C Paramedical —T ~
Purpose of Referral
I
Invest
igation
Consultation
with
Specialists
No. of patients followed up and outcome
No.
Outcome (Cured, died, referred to
higher facility, being followed up)
6
7
8
Total
Treatment
Others
Availability of Transport
No. Referred by
Ambulance
No. Referred by Private
Transport
Technical Suppoi-| by higher hospital
framing Activities in updating skills
1. No. of visits by Consultants
Category
2. No. of Demonstration held :
3. Clinical Meeting :
1 [eld / Not held
4. Medical literature updates :
Received / Not received
1. Doctors
2. Technicians (Specify category)
a)
b)
c)
3. Nurses
No. Trained
Institution
Zz Q
Annexure
Referral System
Reporting and Monitoring
Director of Health Services
State Nodal Officer
<-►
Additional Director (Medical)
Project
I
------------------------- ■----------------------- 1
Consultant
Designated Officers
♦
District Referral Subcommittee
District Surgeon
Designated Officers
Monitoring
Reporting
Taluka Referral Subcommittee
Taluka Medical Officer
CHC
CHC
▼
C
l
i
_i____
PHC
PHC
PHC
PHC
I
Deputy Director
Envi.ro
Nment.al
■ SANS-
person
al
hygiene
taticn
k
0ALAN. CED
DIET
SOCIAL
MEDI
GENE
A A
i A
mental
health
i
YOG.'C
EXER
CISE
IMMUN
IZATION
SOCIAL
■
&
psycho
logical.
primary
preventive!
LU
r
VOCAT
IONAL
I
CARE
MEDICAL
<
dimensions'
OF HEALTH j
J
I
2
<
CARE
O
c
second- :
.. ary
CARE
?
T
J
PROMOTIVE
J
•I
TERTIARY •
CARE i
J
v
NUTRition
i
j
SEX
educa-
.TIUON
r
HEALTH
& MEDIC
AL EDU
CATION
HEALTH
ECONO
MICS
POPUL
ATION
CONTROL
health
care
social
medicine
INTEGR
ATED.
RESEA
RCH
16
-
v.-?v
'5
4s
TRAUMA CARE
DRK.NAGARAJO
PROFESSOR OF ORTHOPAEDICS
GOVERNMENT MEDICAL COLLEGE/
VICTORIA HOSPITAL
BANGALORE.
In taking tins topic for todays consideration in Hying to speak to you, the medical
o icers who are working in rural areas in heating Orthopaedic emergencies, I have taken
U0'1Mf|'''Cae'e fnC'litie5 that !lle P,esent in r"rf’1
lo give treatment in
oi mg fiist aid foi Oi tlu opacdic emergencies.
situation is that, patient is accompanied by' innumerable friends or relatives,
who
accompany the patient with anguish, agony, sometimes aggressiveness and some times even
with amazement to see what dramatic treatment youwill give to the patient to save the life
and treat the fracture.
I have also taken into consideration, how do the injured patient comes to the referral
lospital, even with minimum lack of attention to the injured part which would have made a
aige and substantial difference in saving tlie life of the patient and also in preventing the
^^L^L’O'’JM1v2|I.a'ise because of such lapse either at the place of accident or at the
neatest health centre wlicre-tliOccidentJias takcii placers.----- •—
In speaking so, I have also taken into consideration about the injured patient who
comes all the way from his village to a medical college hospital in a crowed and
ncomfoi table inode of transport with pain and agony accompanied by family members and
bus depuymg the earning capacity of tire family members who accompany the patient just
01 a simple treatment for condition like fracture clavicle, recurrent shoulder dislocation and
so on which can be easily treated in a rural set up in alleviating pain and restoring comfort to
It has been our observation that many patient who come to us with such simple
mctuie crowed our out patient , disrupting our attention from the crictically injured who
certainly deserve our attention in (he medical college hospital.
hi speaking so, I have also taken into consdieration what is know as ‘Ciohlcn I lour’ in
niaiiageiiig the injured. This ‘Golden Hour’ is (lie first hour of (he occuraucc of the
accident and any treatment in this first golden hour will make a lasting contribution in
saving, the hie ol (he patient and making a belter prognosis instead of just referring the
patient in major hoospital where such ‘Golden Hour’ is lost in transportation time.
C
hen I sp.u ■•ouul the ways and methods of treatment which
but effective sometimes touching upon what looks like a treatment i ^ic absolutely simple
- V an osteopath for a
fracture treatment.
rr Cl1’ Wliat've nced 10 «ivc effective first aid.in treating the in: med in a rural set .m
as OKura'cc 0"-%"°' °?a “'f"'
"‘e
l"“ ‘'■'S0 P--cvcnu 'wtat is .
ti
.nay^ove
lranSPOna"T
and visceral structurp<;
/
• c ,
injur.ng the neurovascular
uctuics making .a poor prognosis for the condition of the patient.
In speaking so, I have classified the approoach for the cx-nnin-• inn
i < 1.'
. c
the injured into 2 phases'
1 C t"x‘l,niIU-1on and treatment of
11 ‘hC S'tC ’r lhc accid™ «!•<«
may be called LotasC „(““TTnt,r 'h‘
f major disaster and massive casualties or
H t',a‘ y0U arC a “-P^senger either in the
.........
“ D°C“’r
the patient may be a s'-ntle in* ' f’ m
Aeroplane or in the lUm J 1
“"I “
|= eSied to treat the
you don't have'nZeomZVr5 7 77
the accident when the su™ 7
alleviate die stiffcrl ZZjS
II Pliasc:-
piesen
7“ y™r l'a'’dS
and say
ail
f 7 2°“ a"d y°U Ca" d° "“''""d
>'°U W“" h0P°
trc‘"
l|ial scene of
'’ali“' aad *
The Surgical tratinent in the Hospital
. 1 W0lll(J dke to deal in detail for the treatment of
I phase, where you are
y site of injured without any proper medical facilities.
A. Examine the patient for general conditions whether the patient is conscious or not.
B. Whcthci pulse is present, its rate/voluine.
C. Whether the patient has got head injury
of head ittjnry where you
dAZ^t'Ci'" a Z
there are.‘Tell-Tale•’ signs
'
to cover the wound and refer him/lie’r to
Surgeon to tell about that
.........
“ maJ°r '‘“P'taL A"y how 1
livc 11 10 Ncurot asccpt.
About the Orthopaedic causes for the Unconsciousness aje :
1. Hypovolemic shock
2. Neurogenic shock.
CUNICAL SIGNS <'!' HYI’OVOLICIVIIC SHOCK
In addition m unconsciousness, there will be profuse swemiirn
2
cold skin and
blood. transtLsimf,:""1/^ ^'Povolcmic shock, the loss of th - |,|
t i
(,Ie tissue perfusion °cli y11*011 IC<1H'y hC,pS l° ovcrcoine from livno'
MS l° bc rcsl°rcd by
ni°re tlian 3-5 nmu^ "X
l’''a,n’ as
bram docsH?
to restore
iniin: ics. I
beb in a long w/‘ n
15,0,1 W‘th I V «kic°sc with vnsooress '' i l0'C1'alC an°xia f°r
w
^yBut
effective first step ;•> c? ’“’S 3 infusion wi"' P'asma expandem ilk'"?5 ,S
goin« t0
'be blood in rural scum £?a,H!S !,yP0V0lemic sbock- But I knovv tl^ dtff^In°CCOe! is
bloodistoberest-r.p l’ . J0'1 111S dlfficu,t evC[1 >n urban setup I3ir~ii Jcu ly of sccuring
—d hy biood alone for the comeclion of i^X'cTX 'tal°f
■'>= doo7I‘
7,j to "■
scuss'“bo
.
t'ying
discuss.;
' “> hypovolemic st,ok, the prcsc„c„
the P^ient for evidence of hypovolc °/X|lC1 "a! W0UIlcJ makes
treat it.. But -{ to examine
.' m”1'"6 the
would
like
hypovolemic shock
t0 SlrCSS herc onc COI”plicaHon k-iT S 10Ck and attcmPf
external wound
\
C<J in(emal bleeding”, which is nm
t0 clevc,°pmcnt of
developing hvoovnl'"’^
d°CtOr -° deve'op coinplaccncv
Outsidc. without any
within the body cavd?'0 Sii°Ck Widch Can kil! lhe Patient witliTcc11? pofs,bllty of patient
within the thigh muscles’anff
bl°Od
accumuIate in the che^ cTwt^^rf1^'^
'
iJL
and
a
'so
dorsolumber
fascial laver. r f
avity. pelvic cavity,
of the blood
-J can accumulate in the pelvic cavity leading on o I
f'6 Pelvis Upt0 2 litr«
1 reQuest you to’ I,ote that number of young lives are lot? ypovoieinic s'>ock and death,
bleeding which is not
easily recongizible from the outside
t0 "“s °CCult or hidden
^WQGENKlSlipc^
Here there
-- iis no 1'oss of Hood outside the vascular tree. Here it is dis
distributed and
accumulated in the dilatedlo
of oxygen to f 1C ^rniIL leading onto i
external injury and more
" -...1 who ge" is
r, -V '“,1 1,0
siS"s
but may be a bystander than this the individual '
by the jX '^7
or aa relative
relative who
who is
is aghast
aghast by
shocking news.
y
^cene Lacturc site or hears
What
in treatment of rdown on the
--••ig both the lower limbs
minutes; wherein the ac.ulI1
...... |ccum|ated blood in the dilated vessels ori’7 I
''7 ,Cvd ftr 2-3
ot the trunk and to the brain
.
-J vessels of the Jo
■' restoraling
circulation and
ox 2° , ' , leading
0W5 '"nte n°ws tack
g mrculanon
and oxygenation
-At the consciousness of the Patient.
ygonation leacing on to regaining
. .........
.x.-;
“
5 77
he u„ab,c t0 move
"
'7
"7' I1'•’’"'■Ma..... el. is io be no c? o I S' ‘j5'®"'5.... . ,l,c
'’.'ilicnt to till
.. iX77"'
"is a->
>7.7.7'7:; 77ir"c IS '■>
cci Vical spine and also rule
... .I"• ,iri.......
.. 77
6
2. Ask the '•'kent to hft both upper limbs above the head -vel mi
1 ule out major frac: . .............................................. --ddl-raetjXr4:;i:TZS .
nnd phalanges.
3. Examinati
for fracture ribs: Keep you both hand
Press upon the
>th your finger spread,
:iSpCCTfU1C CheSt oft^ Patient in I
fracture ribs plying Town positon and if the
Tbs 'UC'W|II bc cllI>‘cal signs of tenderness
the fracture of the
■’ ''■ill. crepitus wihei suggests
cal,ed-
hold outer aspect of the ilium iust'below tbp if
’ a Wa? that Outer four fingers
11^^ antriOr Sl:pCri°r ,Iia= sPinc in the liac fossT'r
PreSS'ng on inner
hands towards midline, in the event of fracture there kt, C0,nTrcssi«" test, press both the
0" the eHher side towards the midline or there X b t l" "
°rtlle Pdv‘c ^nes
>hc chmeal evidence for fracture pcivics Ir X tendcr,,css
-'fcpitus winch
suggests
pnmaty factor to push awiv the lJu ti ' i
ietraclIOn tcst use the thumb r
pressure
as (he
of presence of fracture of pkvis there
b
PCiV'S fr0'n cacl1 ollierIn the aevent
from midfine or there coufd be presencTof cliniTalT"'/
peJvis
W
of the pelvis
examination for fracture pelvis is tn
1
gn of tcndci‘ness or
crepitus. The 3rd
"’,11 'adlra'c fracture ofthe pubic rare’ “ “P°"
P“bl'c ri,m' 10 clicit Kxdcmes, which
5. Lower limb fractures'
11 he can do so, this rules out a : Here ask the patient to lift the Io'wcr limbs one by one and
major fractures and dislocati on of lowe
could be a fracture of tarsal,
-r limbs but still there
metatarsal and phalanges.
6. Examination nl dorsolumber spine:
Here k IS of u|(i]os, il])p()rt;i[]cc dl ijic
p^lient must be turned
-s a single block with 5
pelvis and lower limbs
Persons suppmtmg head, shoulders, chest
to prevent the conversion of
of a simple vcrlcbral mjmy whjd, ..... , ’
^cti(cd fairly well u"
- '"to a spinal cord
ini
--injury
m
the event of which
disasterous (-----patient will develop
consequences of developing
developing paraplegia
paraplegia. 5^ w
support rendeijed in
■o do degree from the ground, the vertebral
injuries are determined by the
" science < ” ' ‘
“f—-".i.i.*... xksi
■ elicited by
TREATMENT ASPECT:
1- Ccivical spine inmrv ■
ThH' thn
Ta <c a newspaper, fold it fork 10 11CasUrei”etl[ by y°ur fingers of the breadth of the neck
Umh of the neck and 0 d n ci'X, °
^l'' Or,''C
=»n«po.
,1
l0'!’ -loth or drrrrpr,,,.., „r
of ,be ■"W' 10
tail in lire ends “i t "
"■'j newspaper fold and envelop itVrold^ 'TT “ l0"S a"d “ b: 'wd cl011' Bnioso
4 in sncl, a manner rhe,'
b3X ofljTv8 i"“.’ l0"fi " ’4^
ter and the slernum. lire lailcd ends are use(j t0 ri .. 1 ^l’‘ll’e' spi'nl - 'mes in belwccrl lire
1’ojlcnor aspect of the neck ami tic the cloth ends to lit I C°VCr ' 'C
10 =IJ';IC °vcr lite
-Areal spine and send hir„
10 "’a ta-l<
th- neck ............ 3biliel the
hZXzX.
. . .....
* XZ.:-gXZZXi'Z
extending over be uc, of ’ r , f
/
" 8
°'a'"C'C by !'l, a‘ll'css™ P1”1"
,
L
mca of affected clavicle anterio posteriorly binding the fractural clavicle
to the surrounding chest wall. If
no plaster available suspend the limb to the neck with a
cloth. ■
4. riacturc of Humerus: Strap or bind humerus to the side of trunk with anv lorw clmh
ZX1 £ X ,k'bcq"“k
noxio„.'lf yot doi r
a ,?"v;o,b '?"•e,b™
t,7pi;n,OT 3Aside,s,°fthe arm a-d b^=^x xxx
“xs1
..owspapcSfod . k a
C1UrCt
'’f “Ona' mC"IOd 'S 10 -ak' ” .naurXncor a
>0 the Ie„ .th of t ' ,Si
° ,',na r ‘I mOti“alley lbick P«l«r splint and ent it according
this wtdt fdoth to bZob'bz^XXX
y ma8aZ",e °r by ne'VSpaP'r
a"d -
:±:; zxis zso
«.o
eXVlbe'^n »kh™ey ‘1° 7""l" ‘l^ S?aP°d SP’inti”'d bi"d "’is Sp'inl by a c'Mh
supporting theTpHn.1
P
°
PapCI’ SpIint across lhe elbow
3. Shoulder dislocation: Make the patient lay down, hold lateral side of the chect w->ll b
,o,te ",e ci'csi
ti,“
y°ur bMh b-^.no uS,:
ock the lingcis together on to the medial aspect of humerus oroximnllv anH
and thiS “ SUl'rCiCen‘ t0 re<lu,:c l"''“Motion
wXs^n’uvcT we7dS ““
-
'
naneuvci. we have got greater chances of obtaining reduction and narticularlv so
" a™“
s °Ca"D" a"f W,! lnaj; ?l“.’““«■! i" lhe 1st episode of shoulder dislocadon
where muscle spasm may be quite high in preventing successful reduction of the shoulder
dislocation.
theXw"^"^ W±
*ay d0T" •' H0ld ,"c
tu ""=
^ove
the
X,S“n8,0 SUSPCnd '"C lirab' we - a'“
“„0bS
by SXXs ZkXzZt. Sl,""ar <0 ,he ,rea,meM Sl'£scsled for fr“urc °f —J'- Fracture of the nlial: 'nges: Immo.ilizc the fractured fin;,er by strappig it to the next
normal finger by 2 ems :nmies.vc plaster which is avadbalc as band-aid at 2 places (proximal
& distal Inimoboh'.’ition)). Normal finger acts as a splint for immobilization for the
iVactured phalaiw.es
v- Hacliuc lox'/cr o' ’mil'-::
Keep a walking stick or a Ihnbwlh onto the outer side of the
foiciure linil) and j- •i IV|'
y^\J”nb at 4 sites atleast for splintage and trasnport to a
iinor hosnilnl. I!’ noauitlable tic the norma! limb to the alfccled limb wuh a cloth at 7
■'!;!'
•
oO
multiple sites to i
1 mobilize lhe injured limb u herein a notnial liin:
injured limb in p.i'up him immobilization.
10.
■'icls as a Splint for the
Foot injuries
Wrap the foot iin a head pillow and bind the foot in
ti’anspormion to n: X hospital
the pillow for
etnnhf0,S01U”1L,C' Spillc:
■p,crc 1 would not like to use the wor ' t
f'.f C'”.t "ie deelopment of complication of paraplegia itreatment. My great
in shifting the patient
H single block by
g^thf boT'ifiLlbT
’S t0
slllfted
as
the patient on to a wooden plan!- Anothe 1Um g ,° P ^CCS dy Illl,llter of persons and shift
fed sheet, slide under the fX tfod^Z^
S
1S t0
3 t,lick aad a strong
from theTd
01 tllc bed sheets to shift the patient to the ambulance.P" 'Cm a
CdgCS and COrncrs
atXX"T ‘T’°' "’a'1
s.er.le
a
the wound,• use a dean Itnndkerchief, a long clea„ towel a Io „ le - Z T"’"L"
clean pancha c
or a snree and tl,is is enough to cover the woun’d fC. , W,
' P’Ke °f 3
c,||(|
X, T
"S dd ,hus
prevent furliter con>a,„i„!io„, ,„i„i,nizc b|ccd,
wound. In the t
event of uncontrollable blecdi,,- use a
, h
eoven,ig to tl,c
avadable ,s a rura! set ,lp is lllc ct.rf of , B.p ^XtL'
'U ' l''C b“l ,0"rai'l“ Um is
H phase ’■•catment
the Hospital:
preventing i,,lectio,,, saving die''lifc’^pafen'a^'gof<?i(r'Uce
in p
b.ealing and even in the
]n the first 6 hours of the
giving rise to poor prognosis in wound healing.
wound to
deemed
to have infected
deemed
have infected
arc .f th c ‘opei aUon jheatrefv H
4ridcmcnt which if dime
WOmd
"’here you can inspect the wound very will for die nrcsen
,.llu;illn!ltion is Present ,
nieces, 'vood pieces and sand particles & etc and aisfvi
ui'f
'’(,<,'CS likc «,ass
for
tissue viability,
............
.
A, n..st Lage
coper wound with ■<
! stenlc towel, wash surrounding area with so-uf
I U' " f°rccp''; and
Surrounding area,
inspect the wound
brick red in colom;
by knife.
aie aosent the muscle tissue s (Imd nnJ ii^ r
oxision to prevent the
to i—
’
... ........
'•’•idebore needle■y
of W.S.JOn,,,! nush out a..... .. ,n„ I ,^,0“ “ < ST T
hi ch m i."J it be
1 wilhin the muscle layers and
;,iOgnosis in woim.'
.. ■Xi"1........ .. —<t
.dXHXX
I
S'
e1^"" 'v"icb
N'‘ „
l,-v
" " ilh paraffin girazc and dress^nu N
Note dre „SS0CKIC(i
netroeasenlar X f
cl“c "'c ”OUW
''d
skm
.be pan Md send the
Even . if 3'ou do not have the O.T facility, remove the ,
in-igate ; ’
nuuor foriegn bodies, wash ,
‘tK jec 1 ic wound with normal saline and flush out the
the infective
-- smaller foreign bodies and
■'inalCri:ii by * 20CC syringe as described above
oXTdXtXnd
0 “'7 "'1
slCi,s "«<* arc simple and
d,el±™SoXS
'-"S .he nv.™, n, rn,,.,
and treatment in
’-‘nicrgcncics.
^••7
Office Procedures
K-R-sRINIVAS
hief Administrative Officer
Office P
there are no
difficult forproper ma'
K H.S.D.P.
3
of =uidelines in maintenance of off
lf one ad^s his own proc^ IT
If
Government Office it
of records in Government Offices Wh ” eC°meS
decision, there s J’
officc- As if is a Public office for
*
uniform procedure • C0Untablhty a.nd responsibility. Therefore it is ne^17 aCtl°n °r
procedure m maintenance of office records.
necessary to have
If
"l
General Rules of
Or^^n
office procedures, officially fn u
subseqUe„dyi„191gJ“4fy“d“™4fy' in,ro‘iU“<i
l914- Thev Ue^'vSd
When States r*
reorganisation took place in 1956, there
office procedures prevailing
were four systems of
f the system prevailing in
the erstwhile Govt, of Bombay
old Madras system
> the2 Sta
Government Office Procedures
- the Standmg Orders of Old Mysore area
There
of states. As
manual of
ensure a uniform k—“
was prepared in 1959 and this bee.
the procedures^nd to^ake a’T ™S
Committee to look ,„t0
det‘iled °ne, there ■
was a need to simplify
>"
the Gov.
Officee Procedures. The
office, head of a branch, head of a tecfaX” teXTe 'X'X"
organisation of an office.
procedures relatins
Processing of files,
» A"aXXTof
,he
1
closed files in the record room. It also deals with the types of inspection to be
conducted in an office.
Organisation of the office: There is no need to have various branches and
section in an office if the office is ven1 small. Normally an office is divided into
branches if
a) the nature of work is such that it can be clearly divided into district units
having practically little relationship with each other.
b) the branch is supervised by an officer to whom a number of duties of head
of the office can be conveniently delegated.
Each branch will be sub-dwided into a number of sections and each section
will have number of compilations. Each compilation has a definite subject to be dealt
I
with.
Duties of Head of the office
> to arrange for the speedy and smooth disposal of work
> to organise his office into suitable branch, section and compilation
(wherever necessary)
> to assign work to each case worker
> to ensure proper replies to the public
> to visit periodically the different section in his office, inspect table and
ensure that the case worker is discharging his duties efficiently.
Duties of the Head of the Branch
> to take care of most of the day-to-day work relating to his branch
> to place before head of the office such papers which statutorily require his
approval
> to be responsible for efficient management of the work
Duties of Head of the Section
> to exercise general supervision over his section
> to guide the inexperienced case workers
> to-be conversant with more important files of his section
> to ensure that the case worker maintains his Case Register, Special Register
properly
> to ensure that the outgoing papers are not delayed and incoming papers are
obtained with proper remainders
> to ensure that monthly arrears list and weekly arrear list is duly submitted
> to ensure that the case worker does not delay in disposal of cases
> to deal himself with complicated cases
9
■
!
to ensure
that the case
Proper cha.,rge Hst
worker on
^nsfer hands
to inspect tlhe Wori< of case
over and
takes over
Duties
Worker.
wj;h
0/ a Case Vy,
orker
■ .7
■ I
■
/
be ir
trusted
for the work
t0 arrange Papers and cases I
““ connecIed w,th
K
he
conve;
COmPilation
K
t0 ensure th.'
'SSU'S'» be deoided
> t0 Maintain ail
no delay in s , etc. - Elating to hts
COmPilatiOn
to
,of files
ensure th.
deSpatch sectio.
“tX“ -PonS,We
ap7XMdf*'-pp« 3re putup fOf
aPProval
I(K office
office ,Is
■ firs,
to^S28’S'v"''eblnthe
case
case WOrke« under"
^'aai Recelpis. ne'entered i; •
■Jwiedgement. n Papers
The case
'V<’rfcr.bastOs„„
Prop'rfi'«.NWmail>th
fRefaenee,
an^ scnt to
^’ster by the
■le c°ncemed
t0 Place
" New refers. Pertainn"eto a pending
fnce$
them in
The new referPn
Terences
^nerallyfall
Under3 categories;
> Terences ;
reiatins to th
dlStinct registl
*•
tne f •
subJects COn^°n to the deparr
Periodica]
department fOr
Mlscellaneous
reCre",-Dai«
T,
r2e
which
The case
references w°rker
enters in th
'ferences ere Kte are taken t“the files alreTd^'/eTd i” resp'ct of
t0 fhe Cas
icrerence.
new references
Worker Tbp
_ the
.
‘
new
pending
- -“typeofthe
Eveny file,.while Sj
S'wng number ■
a ^mber - •
fl],
. e w'th a trilatera;-.'
is ; ‘ ”
is written 1
given inf
r
therefore
6313 whh
dse Register is'o'?
i~
object
me.
- - - each case is
n
7
given to
^-nt
‘
°ned
in
the
C(
F
ReriM.ralRe^“fi^ = -^
e Die. T^e
-■umbers are 7ase ^egister
- and the
F-orm No fl Th
-‘ster: A n
year which giVen serially
In the
■ j- benurnberofD
Case Worker h
!lthas arlssn
‘ns Periodical RPcrofAgister, h
has to
Maintain
•
PewCal re^ter m
"ttreber ofoJt,-
Zhave
:,
x
d
e
;
hcbrKf
t
i
t
i
"£p^ c2e ‘CI ma"er •
-s'er“ii,b»«..cLX
be ent
ered
^-'l^-^cais.
At th
the end of
-Jroom.
4.
54
Case Register: It has to be maintained for each compilation in Form III
When references or cases are sent out in original, mention shall be made in the
remarks column giving information on date of despatch and to which office it is sent.
The final disposal is noted in Column 5 and records keeper’s acknowledgement
obtained. At the commencement of the year, the pending file::s are brought forward to
the new Register.
Circular Files: The case worker should maintain a circular file for each compilation
in which Government Orders, Circulars, Orders of a General nature issued by
Government and Head of Department will be chronologically arransed.
At the beginning of every month, the case worker should prepared monthly
arrears list in Form IV for each 'compilation. The lists of all compilation
i should be
consolidated and putup to the Head of the office.
Similarly on the last working day of each week, the case worker draws up, the
weekly arrears list in Form V and submitted to section head.
A file consists of two parts - Note File and Correspondence File. Each page
should be numbered and in the note file each paragraph should be numbered. The
papers in the Correspondence File should be Chronologically arranged.
Types of disposals: There are six types of disposal of files:
‘A’ - to be preserved indefinitely
‘B’ - to be preserved for thirty years
C - to be preserved for ten years
CD’ - to be preserved for five years
‘E’ - to be preserved for one year
‘N’ - to papers which are sent out of the office in original for either further
action or records
The Head of Department will prescribe categories of cases which shall be
assigned to the different types of disposals.
Record Room and filing of Records: After a file is closed, it should be properly
indexed and sent to record room with the type of disposal mentioned on the file
jacket.
Inspection:
There are two kinds of inspection:
1. Monthly inspection by Heads of Section
2. Annual inspection by the Head of the office
4
Hospital Infections and Control Procedures
- Dr. (Mrsj Meera Meundi’
Hospital Infection, also called NOSOCOMIAI Infection i <■
T;- infections can be acquired from another patienl. e,SJ,
■
Common Nosocomial infections are of urinary tract
surmc-il w
resp.ratory tracts, d.arrhoea, hepat.tis etc., Now-a-da"
m
• .
'n,eCti°nS' l0Wer
I seudomonoas, E.coli have displaced the earlier causes bv Cm
baC"li C y
gaming importance. The acquisition of different types of orCsm
spread, reservoir hosts being mostly the patients, sL atten£ o thCr *
MRSA jS
Ot'
a<r, carriers of infection (who could be healthy, convalescent etc ) 'm', °rniltes- waterorganisms hke tuberculosis, Aspergillis, droplet viruses etc
e L
'
Gl'
respiratory system causing respective diseases Enteritis hepatitis Las
t0
the spread of organisms. Blood and blood products are culp
fof ?60'6''’5 “ b-
d.seases as AIDS and HepB. The level of immunity of the ho pad
factors, plays an important role m acquisition of the d IT en d
■nvasive procedures, dytotoxin, drug therapy steroid th™
organisms and their antibiotic resistance behaviour.
7
hJ’00
n^
h63"'7
'° °ther
FaCt°rS Hke
'lle
of'
Consequences of Hospital Infection :
Var.es between financial losses to serious illness infection with (R) micro nr '
patient himself can become a source of infection to others
to others in
community.
Prevention of Hospital Infection (3 main strategies)
1.
Exclude the source of infection .
2.
Interrupt the transmission.
3.
Enhance Hosts ability to resist infection
Guidelines for those collecting Blood of patients :
I.
Starts from examining ones own hands for any evidence of h.i.
k
, ■
any present gloves need to be worn
' ’
breaks ln the skln-
2.
After the [proceto.
gloved hmd rcmme g|ovB
meticulously with soap and
Do not recap used needles, they are to be put in ouncture nr r
discarding.
cture proof containers before
H.O.D or Microbiology. BMC. Bangalore
33
4.
5.
Working area/table washed with 0 1% of l'’o Sodium hypochlorite solution
If accidental needle priced injury, encourage the wound to blood, wash hands
thoroughly with soap and water and such injuries should be reponed to (he hieher
authorities.
Hospital Infection Committee - A must
Consists of an ICU Nurse. Medical Officer, Superintendent and Microbiologists
function include.
1.
2.
3.
4.
5.
6.
7.
8.
The
Routine surveillance of OT and critical care units.
Report to the Record Section - any such infections in the prescribed format.
Short causes for various cadre of medical staff mainly Microbiologist and Pharmacist.
Antibiotic policy presented by the Microbiologist and to be followed.
Pharmaceutical Companies to update on newer antibiotics and Equipment.
Notices on universal precautions to be displayed at strategic areas
To enforce and acknowledge the importance of repeated hand washing in various
areas of hospital e.g., OT., Wards, laboratories etc.,
Three important criteria for a good hospital - Electricity / Water / Ar (environment)
Hospital Infection Control Procedures :
1. Cover all open wounds /isolate the patient.
2. Do not mix different pre-operative cases together.
3. Autoclave all dressings.
4. Use disposable syringes / needles / boil for '/z an hour.
5. Incinerate used /soiled dressing.
6. Periodic check of OT, ICU, sick neonatal ward.
7. Thorough daily wash of the wards.
8. Restrict visitors / No slippers
9. Change of clothes before entering the O.T.,
10. Wash hands after each patient - esp. staff nurse/ Doctors.
I 1. Use autoclaved and disposable invasive sets.
12. Frequent change of catheters e.g., IV., urinary etc.,
13. Before and after visit to the house wash hands.
14. Use tissue paper/napkins - No common towel.
, 15. Do not carry hospital disinfectants home.
16. Repeated admissions from different hospitals breed resistant strains
17. For collecting blood use disposable sets, or autoclaved sets.
18. Indiscriminate use of antibiotics avoided.
Prevention and Precautions for HIV’ transmission :
1.
Al samples sent to be screened for HIV are treated as highly infections, as routes of
infection are mainly through blood and blood and blood products.
34
2
Accidental injury could be through needle stick, unsterilized nrP
lab. specimens bleed the site and wash the fingers with soap and
A
frOm
3.
Atays „„ stov„ if 110, usc forccps
4.
oves into I % sodium hypochlorite solution.
n contacL Discard
Masks, gloves, aprons, etc., used in delivering hwh ricL
cases. Do not touch face
mouth etc., without gloved hands.
5.
Do not reuse needle, do not recap, break or bend them.
6.
Avoid mouth
------- 1 to mouth resuscitation.
2.
Isolate infection apd not patient.
Lab. Specimens of cases :
T° be labeled Proper|y and should be double baooed anv .niiu
•. „
and discard specimen into I % hypochlorite.
°
? P gs Wlth 1/(> hypochlorite
Sterilize all linen in autoclave - 60 to 70 deg C
AH soiled line incinerated after soaking in 0.5 !% Sodium hypochlorite.
To deal with a dead body who is HIV positive :
1. Pour bleaching powder/ solution on the body.
2. Pack in a body size plastic bag which is tied thorouohly
3. Do not wash the body.
°
4. Cremate the body.
Other routes of transmission to avoid HIV
High risk behaviour
Practice safe sex.
One faithful partner.
Proper use of condoms
Avoid sex with unknown partners
Avoid drug abuse.
Avoid a puncture / tattooing
Disposable blades to cut hair.
35
Form No, 1
IIAIForm
Name,_____________
------------------------ a8c-------------- -------------------- yr8
Reg. No.
Unlt/Speclallty
Date of Admlsalon
1
Sex Male/Pemale
Ward
Bed
-OSO
I
Date of Discharge
Outcome,
I1
!!
---------------------- Pinal Diagnosis
■J
Antibiotic therapy:
I
Yea/No
■■
If yes
!
(A) For Infection
■■■
:•
1. Infection on admlwlon Yea/No
I
If yea: Date of onset of Infection .
Causative organisms
Antibiotics
I
Duration
From
/!
/
To
/
/
2. Infection pre-operatlve/pre-lnstrumentatlon—Yea/No
If yes: Date of onset of Infection
Causative organisms
Antibiotics
Duration
jo
From
3. Infection post-opcratlvc/poat-lnatrumentatlon—Yea/No
If yea: Date of orjet of Infection
Date of Operatlon/lnatrumcntatlon
Causative organisms
Antibiotics
Duration
From
(B) Forprophylaxis:
To
Yes/No
If yea: Datee of Inoculation.
Vacclne/A raise rum
Tetanus Toxoid
Date.
Antl-tetanus Serum
Anil Gas-gangrene serum
Date.
Date.
Other*
Date.
Type of Infection (check appioprlatc box)
Ur*narY
I
Sycnik |
Lower respiratory
|
Infectious disease
roat-operatlve
Mlscellaneoua (Specify)
Infection Control Sister
I
■
■
■
•
7/i ■
Blood Banks & Trauma Care Centres
in Karnataka
"
_
’
~ Pi'-K.B, Makapur
Blood is an essentia! component of this body whi- movid^
can be no greater serv.ee to humanity than to offer one s Bio h™3"06 t0 !ife- Tll^e
fellow human-being. 'The blood, instead of savinu !ife , 1
‘he ''fe of othe'
contammated. Due to development of MedicarscienceTh^T “ if
IS
preserve and store the blood and issue to the nee^v ThJ R! J o C°me P0SS'bie 10
ask of collecting, testing and storing the whole blood and its
'
‘he
the same ava.lable when needed. It is very much
J components and make
healthy and free from infection. ‘
*‘P asized that the Blood should be
provided for licensing of Blood Banks.
1
P
Cosmetics Rules 1945
are given license after
uf
Contro,,er of India,
h following~ facilities
----- j shall be
^ammodatjon for Blond Banks :
The minimum total area shall be 100 Sq meter I
-th washable Ooor and shall cons.st of followinghying appropriate lighting, ventilation
3 rooms namely ;
I - Room for Registration and Medical
facilities.
~
“*U ™nat-°n with adequate furn.tures and other
2.
Room f0" |B'kOd COlleCtion< this sha11 be Air conditioned)
3.
oom for Laboratory for blood group serology • (This shall h '
4. Room or laboratory for Transmissible diseases lik
"-air conditioned)
"
HI V antI bod
e[c , (Th.s sha)(
cond. ,one .
Hepatitis, Syphilis, Malaria,
5. Room for sterilization and washing
J
6. Refreshment room
7. Store and Records
room.
The laboratories of blood bank shall be used
exclusively for blood bank work only.
R- Equipments :
The eqmpments are stipulated in Pan XII ‘B
are^oT^
C°Smetic Roles of 1945
en e ) of Drugs and Cosmetic Act 1940
are to be provided.
I. Blood Collection Room : D^
O»„or Table/Bed, wilh custlMS of
..BP. .pp.r.,„, r=cov^ be,Js H
Bedside Table, Stethoscope.
.
Director. Slate (1,slIlule orHc:,llb & F:,„|i|v We|f;|rc
36
*
■)
1
4
Refrigerators maintaining temperature between 4"c
and
Htermometer and Alarm dev.ee and a generator fo n ,
.
, 6"c
Equtpments for determination of Hentoelob,n nerce ta e"
up
ermometer for determining the tentpemture
ulood containers
63
wi(h
recorclinu
*
->) Disposable plastic packs as per the specifications of I ISP
) Blood collection bottles
5
c) Anticoagulants Sterile and pyrogen lie-- (’pi) \
A.r
pyrogen free - (’PDA - Al
Disposable sterile bleeding sets
~
"Al/ ACD solution
6.
l"Sp“aW' s“ '"'H
7
.nd
Plastic spikes shall
Emergency equipments
a) Oxygen.cylinder with Mask (Gauge
and pressure Regulator)
b) 5% Glucose or normal saline
c)
Disposable sterile syringes and needles
d)
Disposable sterile l.V. infusion set
e)
Drugs
Ampoules
of Adrenaline,
Nor-arfrnnnr
betamethasone, or Dexa-methasone injection Nor-adrenaline,
Metoclonr 'T
Mephentine.
Asp.rin and spirit Ammonia Aromatic
Metocl°P™nt.de
0
8.
Accessories :
a)
Such as Blankets, Basins, Haemastats, Set Clamps
sponge, forceps, mouth
gauze, dressing jars etc.,
H ’
h) Cotton balls, Adhesive Tapes
c) Denatured spi ' “
' " TTT. I°di',e lic,Uid SOaP' lnJ Pr°^ne. or xylocaine
d) Paper Napkin or Towels.
Refreshnients Services :
wmchedT3 °f refreshment t0 everT donor after
phlebotomy shall be
atched for any adverse reactions.
made and
Laboratory Equipments :
I
2.
Refrigerator
Compound microscope
,
Centrifuge table Imethod
I I11 I kJ
|
4
Waterbath - one ffor 3 70C and another for-560C
6.
Incubator with thermostatic control
Wi viewing box
7. Slen?1 SHaker fOr Ser°l0sical tests for syphilis's.
8.
9. Serological graduated pipettes of various sizes
10. Pipettes (Pasteur)
1 L Glass slides
12. Test tubes / microliterplates (U & V type)
13. -Test tube racks
is W 'lV E| V'5-.kitS Wit” reade' ,or "‘-•pat.tis
15 Wash bottles for filter papers
16. Ice box
37
1 7. I lot air oven
18 Elisa Reader. Washer and Micropipette loi IIIV antibodies tcsliim
Reagents :
1. Standard blood group sere Anti-A. Ami -B. Anti - AB of different brand
different lot numbers
2. Rh - Typing : Sera
3. Reagents for serological tests for syphilis and positive sera for controls
4. Anti human globulin, serum
5. Wax panels and tables
6. RPHA/ Elisa kits for Hepatitis
7. Detergents for cleaning
8. Elisa kits / Rapid Diagnostic kits for HIV Antibody testing.
General Supplies :
1. Autoclave with temperature and pressure recording device
2. Diesel Generator 5 KVA -1
Staff required :
Full time following stall'shall be provided.
1. Medical Officer with MBBS degree of recognized university and 6 months
of experience in Blood Banking.
2. Registered Nurse.
3. Laboratory Technician with adequate experience in Blood Bank activities.
4. Lab. Attender
Mandatory Testing of whole Human Blood :
The licensee has the responsibility of testing blood for the following :
1.
2.
3.
4.
Freedom from HIV antibodies
V.D.R.L.
Malaria
Hepatitis - B
Records to be maintained :
The licensee is required to maintain the following permanent records with all
particulars as stipulated under rules.
1.
2.
3.
4.
5
Blood Donor Register
Blood Stock Register
Issue Register
Register for ACD/CPD/CPD-A solution
Registers For diagnostic reauents used
38
6
Cross matching report of the blood of the pat,ent along with blood hnt.l /1
“
° bollle ' ba=s
7. 1 ranstusion adverse reaction records
8.
Records of purchase of consumables used for Blood Bank
Labels :
Labels to be used for Blood Bags / Bottles
The labels should contain all the information
prescribed under the
law following
colours for each group .
Blood Groups
0
A
Colour of Label
Blue
Y ellow
Pink
White
B
AB
Blood component separate facilities - facilities needed :
e— —■
t^ntd ^Air
s.alr„d
conditioning
Judgment of Hon'ble Supreme Court of India
The Judgment of Hon'ble Supreme Court of India in Writ Petition
n x,
d=l=d <1.96 common cause verses Union of India and others had dL'cred to"
I.
'°
“d s“"
S«s^
. development of Blood
Bank services including services relating to
Banks and launchmg of effective motivation campai^fo reqU'r"ment of Blood
campaign
blood donations.
° for
Or st,rr,ulabng voluntary
2.
AJI the Blood Banks are to be equipped with licenses within a ,
'
period of one year
actio„;xZi^^^ered operationa,,y imp°ssibie
i suitable
J X^’tDonorssi,ou,d
-....
be eliminated in a
<
Post graduate course in Bioed Banking^Xd"
The reolv of action taken was to be submitted by 15,h July 96
as per directions.
PiodiiiisabU-onu/ Hiood Hanks :
I.
-
1 he modernization of Blood banks has been
,
l’rogramme.52 Blood Banks in the State have be^
Na'ional Ajds Control
and financial assistance from Governm»nt of Inrc' apbr°Ved ,or 'Modernization
supply of equipments. (Govt. 3d, AU tonomouV-eLn
pXT
I he development / improvement of Blood IV t- i
i at- 12)
Karnataka Health Systems Development Project /'kiwT bee'’ t:‘ke'’ Up Under
a- "-eluded for improvement / development mdud.m^
Wo t
JUid furnitures
The hst of Blood Banks approved is Appended (wSoP)^'''""'5
List of Blood Banks Enclosed
LIST OF LICENCED BLOOD BANKS IN HIE STA I E
SI
No
1.
DISTRICT
GOVT. BLOOD
BANKS
HANGALORE
PRIVA I E
HOSPITAL BlOOD
BANKS
1. Victoria Hosp.
1. KMC 1 lospitai
2. Manipal Hospital
Hospital______
3. Bangalore Baptist
Mallcshwaram
3. E.S.I. Hosp.
Hospital________
3. Rashtrotluma
4. Jayadeva Inst,
4. Woe hard I Hospital 4. Indian Red Cross
of Cordiology
5. St. Manilas Hosp.
Society
5. Sanjay Gandlii
6. Yellapa Dasappa
5. Bangalore Medical
Accident Hosp.
Hospital_______
Scnicc Trust
6. Kidwai Inst, of
7. St. Johns Hospital
6. Sneha Medical
Oncology
8. St.Philomina
Trust
Hosp.____________
7, N1MHANS.
9. Bangalore _____ 7. BKF Round Table
8, H.A.L Hosp
Childcnfs Hosp.
Blood Bank
9, Command
10. Mallya Hosp.
Hospital
11. M.S.Ramaiah
Teaching Hosp.
12. Bangalore Inst.
of Oncology_____
13.Shifa Hospital &
Research Centre
14, Shushrutlia
Medical Aids &
Research
2. K.C. General
2,
3.
BIDAR
BUAPUR
4,
5.
nr.i .gaum
6.
BELLARY
7.
8.
9.
10.
CH1CKMAGALUR
VOLUNTARY
ORGANISATION
BLOOP BANKS
I Bang.-ilorc Lions
2. Sushruiha,
l.Dislrict Hospital
1.District Hospital
_______ Nil
I District I lospi l a I
Hospital
________ Nil_________
________ Nil
1. B.L.D.E. Hospital
LLions Blood Bank
______ Nil_________
Nil
"
I.K.I.. IL Soc i c I y~s
Nd
1. Bangalore Blood Bank
2. Navccn Blood Bank
3, Grace Blood Bank
4. Shivaji Rao's_______
Blood Bank________
5, Sampige Malleshwaram
Blood Bank
6, Minena Blood Bank
7, Unique Blood Bank
8. Jco van Voluntary
Blood Bank______
9. Shiva Blood Bank
10.Shakihi Blood Bank
________ Nil__________
l.Dr.Gowdars B.Bank
_______ Nil
_l_Bclgaum Blood
Nil
Bank, Bclgaum
l.Gopi Clinical Blood
Bank. Bellan
Nil
Nil
Nil
Dist. Hospital
Nil
Nil
Nil
Nil
Nil
Nil
Nil
Nil
1. Fr.Mullcr Hospital
2. K.M.C.Hospital ,
1. Rolan- Campo
Blood Bank, Pullnr
1 .University Medical
Home______ _
1. Bapuji Hospital
1. K; i nu 11 a ka_C; nicer
Nil
Nil
___ Thcra{)y eV Biood~
Nil
Manipal
3. Mangalore Nursing
11,
12.
BANKS
Nil
1 .District Hospital
2. McdicalCollege
Hospital______
l.Mallcgowda
Disk Hospital
CH1TRADURGA
'
chamarajamagar"
DAKSHINA
KANNADA
private Flood
DAVANGERE
________ Nil
dharwad
1. K.M.C, Hubii
2, South Central
Railway Hosp.
Hubii
Bank
Centre, Mangalore
l.M.R.Diagnoslic Blood
Bank. Hubii
*
L3.
5
’4.
GULDARGA
1 6.
GAD AG
J IASS AN
J^AVERj
. .Lil
kodagu
kop^ala
KOLAR
2?.
l-Disl Hospital
I H.K.E.S,
Blood Bank
------- --------- Nil
~
____
FZil
_
Nil
Nil
----- -
Nil
______ Nil
______ Nil
______ Nil
-------- 1 LUist. 11ospit;11
~~
—znrs.N r, Dist.
_______ Nil__
Nil
__
Nil'
________ Nil
—
______ Nil
MYSORE
22
23.
24
mandya
----
Nil
17 Devaraj Urs
Hospital
_
Medical College
2. General Hosp
Hospital
KGF
1-K.R. Hospital
_L J.S.S. Hospital
KAiaiuic
'—
SHIMOGA
tumkur
UDUPl
L__JjrOTAL
J. District Hosp.
2. Haiti Gold
Mines
;__ mi
28
30
Nil
Nil
Nil
Nil
Nil
Nil
LJndian Medical
Association
Nil
- L-Weldon Laboratory
—Charitable Instilute
- -------- Blood Bank, Shimoga
Nn
Nil
Nil
Nil
Nil
Nil
13
Karnataka
Ason 17-05-99
Nil
Nil
-LGit^Transfusion ExSendeemen 89
‘
Hosp. . Bcihi?
Nil
Nil
_1. District Hosp,
—
Hospital
~
3. Kamakslii Hospital
4. Holds Worth
Memorial Mission
Hosp. Mysore
L.Adicliunchanigiri
_L Nanjappa Thjs:
Hosp.
1. Siddiirtlm Medical
College
~
Nil
~
K.M.C. Manipal
1. Mcgann Hosp.
-^ZThttara kannada"
26-
1- District Hosp. 1
__Nil
.. Nii_
_2. Basappa Memorial
2'
___Nil
■; m.- ♦-
16
87
87
l
Cat c ( cnti cs
The Trauma Care Centres arc wry essential I i the reducing (he Muibidity and
Mortality due to accidents and other causes, as (he Medical care within a hour of
accident is most important, to save lives ot victims
Therefore, the State Government has identified and approved 45 Hospitals which are
located at the National Highway and State Higlw-aj for establishing and upgrading of
Casualties wards / Trauhia Care Centres Each of these centre will cover an area of 50
Kms. Radius. These centres will provide emergency care to the victims of accidents,
violence natural calamities.
Facilities at Trauma care centres ! casualty ward are as follows :
1.
2.
3;
4.
Casualty room
Operation theatre
Emergency ward with IO beds
Laboratory
Each Trauma Care Centres will be provided with wireless equipment and an
Ambulance fitted with wireless equipment. These centre also will be provided with
required furnitures and equipments for the proper functioning of these centres.
List of Trauma Care Centres is appended in Annexure II.
42
Annexure II
List of Trauma Care Centres / Casualty Wards in
Karnataka identified and
approved for establishing n upgrading
lian^alore Division :
1. General Hospital, Ddddaballapur, Bangalore (R) Djst
2. CHC Nelamangala, Bangalore (K) Dist.
3.. General Hospital, Ramanagaram, Bangalore (R.) Dist
4. Dist. Hospital, Kolar
5. Dist. Hospital, Tumkur
6. General Hospital, Shimoga
7. General Hospital, Sagar
8. Dist. Hospital, Chitradurga
9. C.G. Hospital, Davangere
10. General Hospital. Molkalmur
I I. Dist. Hospital, Chickmagalur
12. General Hospital, Tarikere
Mysore Division :
1. General Hospital, Gundlupet
2. General Hospital, Hunsur
3. General Hospital, Kollegal
4. Cheluvamba Hospital, Mysore
5. Dist. Hospital, Madikere
6. General Hospital, Channarayapatna
7. Dist. Hospital, Hassan
8. General Hospital, Sakleshpur
9. Dist. Hospital, Mandya,
10. Wenlock Hospital, Mangalore
1 1. General Hospital, Puttur
12. General Hos’pital, Coondapur
Belgaum Division :
1. Dist. Hospital, Belgaum
2. General Hospital, Nippani
3. Dist. Hosp. Bijapur
4. General Hospital, Hunagund
5. General Hospital, Haveri
6. KMC Hospital, Hubli
7. General Hospital, Honnavar
8. Dist. Hospital, Karwar
9. General Hospital, Sirsi.
43
7(iiilbdr^a Division :
1. Dist. Hospital, Bellary
2. General Hospital, Hospet
3. Dist. Hosp. Bidar
4. General Hospital, Humnabad
5. Dist. Hospital, Gulbarga
6. General Hospital, Shahapur
7. General Hospital, Gangavathi
8. General Hospital, Lingasugur
9. General Hospital, Sindhnoor
10. District Hospital, Raichur.
44
5s
■ ti.'ir x tv ’cr? wit’
MANAGEMENT INFORMATION SYSTEM IN
KARNATAKA HEALTH SYSTEMS DEVELOPMENT PROJECT
Dr. V. S. Rajamma
Deputy Director
K.H.S.D.P.
Under the Karnataka Health Systems Development Project a systematic effort is being
made to improve the functioning of Secondary Hospitals.
Making available the essential
equipment, drugs and chemicals, providing more number of qualified doctors and paramedical
staff, providing better, infrastructure in hospitals, are some of the strategies adopted to bring in
improvements in the medical care system. The Karnataka Health Systems Development Project
extends over a period of 5 years and it is expected that by the end of the project there would be a
substantial change in the quality of the medical care provided in the secondary hospitals.
The Health Systems Development Project is conscious of the existing information flow in
th? health care system. But the flow and processing pattern of information available has not been
very efficient for decision making. In order to create an effective tool for decision making, health
systems development project is planning to develop a management information system. The three
operational objectives for establishing the management systems are as follows:
1.
The management information system should lead to most efficient
use of the referral system in health care sector.
2.
It should lead to the efficient disease surveillance mechanism
3.
It should serve as an efficient tool for decision making
Deficiencies in Current Management Information System
There are some deficiencies in the information flow pattern available in the Department of
Health & Family Welfare :
•
Information for Decision making is never available in time
•
Information is not organised in the right form for decision making
•
Enough information is not available
1
•
A constant view of different aspects is ne^er available, some of the
reports never received from the hospitals
•
Too many reports
Because of the above deficiencies, the use of Information for decision making has been
limited. The Management Information System contemplated under KHSDP aims at rectifying the
above mentioned deficiencies so as to make it an efficient tool for decision making process.
Main Features of Management Information System under K.H.S.D.P.
The KHSDP has
identified the following steps for development of Management
Information System:
•
Classifying : Identification of information needs and the kinds or
classes of data needed to be generated.
•
Collecting : Providing for collection of data like designing forms,
deciding on the persons to collect the data, or retrieve it from already
available sources.
•
Recording : Recording manually, mechanically, or electrically.
•
Sorting : Organising data to facilitate processing.
•
Calculating : Summarising, and analysing, based on some criteria.
•
Storing : For future use.
•
Retrieving . To be able to find the information when needed.
•
Reproducing : For multiple use.
•
Communicating : Delivering output to information user.
\
The Management Information System is expected to serve the following beneficiaries:
•
Secretariat, Ministry of Health
•
Directorate comprising different Directors, Additional Directors, Joint Directors
•
Project Officers managing different programmes and projects
•
District Level Officers attached to the Department and Local Govt. Bodies
•
Health Care Professionals attached to provide a institution
•
Other organisations / bodies associated Health Care Planning & Execution
2
Develop,™., ...d u,s,»lla,i.„ of Ma,.»ge,„«„,
Sjsleil,
K.H S D p
The ul,iMe objecive of KHSDP is ,o deveiop . Ma„ageM ^.ioo System
eovenng each and every heai.b care est.bl.staen, and each and ever, activity o„ a„ 0„lme tasis.
However for the present the action plan for MIS is on the following steps :
1
Develop maooally based Management Infonpation Syaem to monitor and assess the
functmmg of KHSDP hospitals so that the hospital lunctionaries are not taken by
surpnse when computer based Management information System is introduced. This
wdl also help KHSDP to understand rhe strengths and deficiencies-of In-house
Information processing capabilities.
2. Develop manually based reporting format for surveillance of communicable diseases.
3. Develop the habit of bi-directional information flow so as to develop confidence in
both generators and users of information.
4. Computerise data recording, sorting, calculating, storing, retrieving, reproducing and
communicating capabilities at the central monitoring unit o„ an Excel compatible G1S
software.
5. Develop computer based information flow at the level of District and Taluk Hospitals
and link them in a network.
6. Develop query based output packages for better
communication to the information
users.
Development of MIS for monitoring the performance of secondary hospitals
Quality of medical care forms a part of the Total Quality Assurance program that is
proposed for the secondary level hospitals under KHSD?: Measurement of quality care is a
continuous process and involves technical, maoagenal and human factors. Quality assessment
which forms the firs, stage of the program involves development of key indicators and methods
lor periodic assessment of quality of selected aspects of care. Methods to collect data regularly
and establish procedures for reviewing these data and identify shortfalls In the hospitals, forms the
. first steps in assessing quality of care.
- 1
-r kJ
Data Collection:
Towards this objective, a format for collection of utility data on a number of services
delivered by CHCs, Taluka, General and District hospitals was created. The format also includes
a check-list for stock position of essential drugs, functioning status of available equipment,
collection and utilisation status of user charges. It also enables the administrative medical officer
to bring to the notice of the project at least five critical issues which need urgent action fL
ensuring smooth running of the hospital.
A book-let containing these formats along with
guidelines for filling the data on a daily basis was dispatched to all 252 hospitals under the
project.
Standardised format for collecting data on all activities in Project Hospitals along with
guidelines for filling have been given to the Hospitals. (Annexure I).
Data Recording, Sorting, Calculating, Storing: Monthly Performance Indicator reports from
these hospitals are being reviewed in the project office. Errors and omissions noticed in hllirig
various data as well as action taken or initiated on issues of concern are being fed back to the
originators through letters written periodically.
These monthly data are also being fed to
computers for subsequent analysis. Veiy recently the project is planning to develop a CIS basdd
software for this purpose. Presently data is being stored on Windows Excel.
Processing of the Data: The processing of the Data is done through a query based computer
programme. The programme provides processed information on the following with respect to
each hospital.
4
I
Karnataka Mealth Systems Development Project
'c
!
Instructions.for filling the Performance Indicators
I.
2.
■'ll lhe formal in duplicate
duplicate (in
(in white
white and
and vellnw
yello
z-*
I
I
c no no allowed to be filled by others
i
—
obligation to send copies ofthis
reporting format is in two parts, fill the data in Part B
-=X;;;:s... -................ ..... “............................. .
to be produced.
Inorder lobe clear aboiH paliols who should be couu.ed as ■■e,„ergcncy.. cases
’
'
are categorized as following;
a) OPD - those who onnic Io Um OPD outside the tioiinal OPD
IP - those who are admitted as In-patient outside the normal OPD hours,
c) Major Surger, - those In-patients who are taken for pmo
d) Minor Sui'scry - ,l,os= pa.icu.s who undergo
fill
.,. the colum
Or
i" =-h row a, ,be end of,he
I'Tormanon has to be Idled oZ 10^^'Pl""1
Z"'™aito r-—-
"'i,b ,his
C"Vel°P'!
‘ra"<'" 'bel*er
Z"1'"” "" '°'a'
U": Pre“d'"S
"0""a' O'’D bW"S’
"’H'”' 0PD
10 ",e c''™"
zror,te rwm -—-—■ —
bo used for sen^ “
UP P'Or°"Pa •■'"d
asc note (hat caibon copy should not be used to fill the forms in
■luplicuc. They are („ be Nied up separably
9
! ..
•
,
f
i
i
i
i
« be US«I
a„y „,lK,
HOSPITAL ACTIVITY INDICATOR
Formula
Indicator
Total Inpatient (IP)Bed Days
X 100
1) Bed Occupancy Rate
Bed Capacity x 30
2) Turnover Rate
(Bed Capacity xl2)- IP Bed days
------------------------------------------------ X 100
Discharges + Deaths during 12 months
Total IP days from Aug’97 to July 98
3) Average Length of Stay
Discharges + Deaths during same period
No. of Outpatient in a month
4) Out patient per bed day
Bed capacity x 30
5) Cumulative Inpatient day
Inpatient days from Jan to June’98
6) Admission from Jan to June’ 98
Sum of all admission from Jan to June ‘98
Add all OP (New + Old)from Jan-June’98
7) OP Consultation (New + Old)
6
(Total Discharges + Deaths)from Aug’97 to July ‘98
8) Case Flow Rate
Total Bed Capacity
Total Deaths from Jan - June ‘98
9) Gross Death Rate
Total discharge during same period
The performance Indicators of each of these hospitals arc being analysed and compared
with corresponding data of previous years as well as other hospitals. With respect to each
hospital, the above mentioned performance indicators are developed.
Review of performance of hospitals :
The reports developed in this manner are communicate to the respective hospitals has well
as the supervisor officers indicating the deficiency in performance. As first step towards getting
5
data. .„d sensiiising hospita, ....... .............. ,o„„ds
nna ton systen, .we
the project write ierter giving
of
them where ever necessary.
6
Training and Review Workshops have been conduoted for 33 hospitais in batches
PrZ
“3
fT
for sevX ‘ , WTP
On
bee" e“'“ed “ Amemre Aj’Mher b’Kh °f
™
or seven hospitals will be conducted in the month of June 1999.
No ofs
‘“'a “Cl’ Be<i 0“UP”Cy
AV'r"8' L“S.h SUy, Total
I996
7s' de"VeneS fOr 1998
— spared with those of .,97 and
6 to observe any ehan8i„s .tends, Contpattson h.™ been ntade for 40 hospit.N of the
project. One of the sample is enclosed as Annexure.
6
TALUKA LEVEL HOSPITAL KUNIQAL
cd Capacity 30
4 otal Number 1 otal Number
oflP
of OP
'fotal No.of patients
(including
(including
referred out
discharged
Emergency)
Emergency)
'i’eu r
1996
519
1997
784
1156
45590
5
720
Investigations
Lab Test
X-ray
819
2525
300
825
1076
1047
676
508
761
16)8
1183
Emergency)
16799
134095
1998
Total No. Total Number Total Number
of
of Surgeries
of deliveries
deaths
(including
(including
Emergency)
No. of
Linen
Calls
washed Allende
d
25
2260
1 14
69
Hospital Activity Indicators for Kunigal Hospital
Year
BOR %
IQ96
1997
1 998
4.74
000
7.16
TOR
0.00
0.11
0.07
ALS
OPD
//DIV/01
0.00
1.08
1.53
3.11
4.16
Percentage of
X-rays
Lab tests
1.73
14.58
1.98
3.07
2.55
3.49
Bed Occupancy Rate
SCO
6.0)
Out Patient Per Bed Day
7.16
T
5.00 t
□ 1996
□ 1997
□ 1998
4 00 i
2.M 4
o ( X) -I----
199o
-
I-
1996
□ 1996
□ 1997
a 1998
100
200
—t
1996
1997
1998
400 200 -
0 --
1998
1996
1997
2525
2000 - ■
600 -
0
1997
600
Total Number of Lab Tests
3000
2500
761
SOO -
□ 1996
□ 1997
□ 1998
1.53
i.oo 0.00
825
800
3.00
2.00
1998
1076
819
1000
3.11
I otal Number of deliveries
1000 •
Total Number of Surgcrlca
4.16
4.00 --
4.74
0.00
I-----1997
BOR - Remaining patients /(Bed Capacily*365)* 100
TOR “(Annual total discharges + deaths/Total Bed Capacity
OPD = Total Annual OP/Bed Capacity ♦ 365
ALS = Remaining Patients / (Patients discharged+Patienls died)
1618
1500 1000 -
□ 1996
□ 1997
Q 1998
1047
500 -■
0 --
1996
1997
1998
■■ :! ?
BOR : Bed Occupancy Rate
TOR : Turn Over Rate
fe
ALS : Average Length of Stay
OPD : Out Patient Per Bed Day
4*
Comp-Anj.XLs ■'
: r.
__ I 'ci h hi i ki i ice liKlicatois ol the................................................................. Hospital lof inonili ol...................
To be filled by Administrative Medical Officer or the l/c Medical Officer
Please cnfCr correct aiid factuul (lata legibly with a pencil within space provided to help computiH^
■
!
P.u l
Proposed Paying
Proposed Beds
Paying
Existing
Beds
Month
Year
Type
Place
District
Code
i >
Pari-B
Date
Data on_____ __
Item
______ Sub-item
In- Patients
11*1) Number_________
(include
emergency
Rciniihiing Pts.*
IP)
Pts, discharged
1
2
3
4
5
6
7
8
9
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Monthly
Cumulative
Total
Total
New admissions
«
Pts, died_____________
Pts, referred out**
Out-1‘alieilts
OPl) New
include enie-
OPD Old
i
rgencyOl'D
Surgery
(■
Major_____________
.Minor_____________
llubpital
Deliveries
■Normal___________
High Risk
Caesarean
I'.nuTgenc)
i Invcaligalioiis
E
OPD______________
IP ______________
7.
Major surgery
Minor surgery
X-ray________
ECG_________
b
I
L'ltra Sound_______
1 -aburaiorx
Hactnatalogy
■ I cals done
Serology__________
£
Blood Grouping
HIV
Sputiini(graiu)
Cult. A Sensitivity
Stool_________
Urine
£
__________
CSC
Post Murtcms
lluspital
I Dejlhs
IP _____________
Emergency
Si
Infants__________
Maternal________ _
f'ust opci am e
Emergency_______
( asuaitics
Planned
Amount
Bed Charge______
V-
1 ests
Krccix eil
Calls Attended by the Ambulance
|Signuture of MO De____________ _
No. of patients iciu.iining limn ycsierda)
of p.ilienls ti .insh i v<l Io oilier hospitals
ll’l) - In Patient Department
()I‘D Out Patient Depailinenl
/’/ I ( IK
yn
I’crforinance Indicators of the
Hospital for month of.
- .■■•■e
t5j«ra ikat the Aminisirath'e Medical nfc,^
Would l.ke to bring ,0 ihe notice of the Project AdnnnistratoCKHSDr
SI No.
1
_________ ------------- ‘^rdiatriyfor belter hospital performance
_____
Issues
~
7~~
---------- —-------------- —_________ Action taken
I
Stock of important Drugs.:
-------- -----
__ Ljj'.L’s
Signature
Slock
Paracetamol
\stntiin of eqnipmcuts
. s n» the end ol •]
month of 191)7/93
| I
X;l<jy’"'
Glfia Sound
Bowel Steriliser
__________________________________________________________
Autoclave
Lj--’lLa?0^dinc
J
’
2
Gynac ( PM
Metelopramide
Genficin eye drops
Met h erg in
Buscopan
Inj. Atropine
3
i
Dcryfillin________
Anti snake venom
3
4
Shadowless LanirpofpJ .
Air conditioners
Generator
Inverter
Centrifuge
J’I a co n j ajeep fr idee
__ Refrigerator
- J^utethcrapy unit
Apparatus
___ Operating table
- .--I!Gjpp.App a rat us
---- ijuergency resuscitation kit
•i’ I
I
zUl
4
•1
Multivitae
Ghicose Saline
Dextrose Saline
LNormale Saline
-------- — -LqtlljLscr Charges co I let I cd
------------ during the year
—---------- LptaUJser Charges utiliscd~
~
_______ during the_ycar
~
5
Comment, by the Inject Administrator
___
S^iaturcof Project AdminjMn.fn.-
£3
Hospital Administration
- Dr. C.M. Francis
A hospital is a unique organization. What are tlie special features of the hospital, with
respect co its management and administration ?
>
1
The hospital (including the Community Health Centre - first referral unit)
>
Provides personalized and individualized care ;
Must be highly responsive to the expectations of the people seeking care
Must be involved in providing referral services for primary health care ; often it is
the first contact of health care;
must cope with emergency care; management of crisis becomes integral part of
management by objectives;
K
A mistake can end up with loss of life or chronic disability;
has a team of professionals and non-professionals;
has difficulty in providing rewards or punishments;
4»
4»
)
)
Given all these difficulties, hospital administration can lead to
a great degree of
satisfaction.
A hospital administrator is a manager of resources :
persons, materials, machines,
money, time and information .
More importantly, a hospital administrator is the conceiver of goals, policy formulator
t^Svemment
°f
P°liCieS’ °bjeCtlVeS and strateSies of
A hospital provides services,
involved in research.
Additionally, it is involved iin training.
It may be
A hospital must be involved iin community health. Health education must become an
integral part of its activity.
Initiator of changes
The hospital administrator :
> responds to changes in
♦ the situation
♦ the medical science and technology
♦ concepts of health care; ’
< is open to the changing needs and acts to meet those needs
•
Hospital Administration Consultant. Ex-Dean St. John's Medical College
17
-3
exercises positive influence to make things happen;
is dynamic and innovative.
To be an efFective administrator, it is necessary for the hospital administrator to
" prov.ded^ the °bjeCtlVeS °f the h0Spital’ the Pe°Ple and
services to be
integrate’and coordinate the work in the hospital;
provide leadership;
< build teams; and
< be creative
Problems
ol
.»7X'
as challenges
people. The problems
—
.. is necessary
be “a,y"d a"d *11 ‘
Planning
An imponant part of hospital administration is nlannino
objective oriented planning. We go through the planning cycle
Communication
u . ■
t
i
Failure in administration is often due to faulty communicanon
process. Listening is a veiy important part of communication.
It is a two-way
Delegation
Every administrator must be able to delegate some nf th» r'
■responsibilhy . i. is necessary .0 give the needed author!“also
ur ■
S“nS
Decision - making
The most important requirement of an administrator is tn man
implement those decisions. To make correct decisions i T nee
much relevant informat.on and evaluate the information ’ Once a H
demented, it must be evaluated to ensure that
•
decisio"s and
'.
Personnel management
most important task ol a hospital administrator
The management of
Managing people is the
18
It may not be within the hands of the hospital admin.strator to select and appoint the
right kind of the people. But it should be possible to
*
*
maintain good inter-personal relationships; and
ensure that the staff carry out their’ responsibilities with competence and
compassion, believing in the dignity of the persons under their care
Training
Every member of the staff in the hospital must-be skilled
qualifications, appropriate training has to be given.
It means that apart from the
Employees’ problems
Employees will have problems. There must be a machine,-,,
grievances. They have to be solved quickly and with fairn? 1 •
the e^oyee-s e„mpla,„,s Ac,Ion ^s,
.
'°
emp 0-',£e s
°P" 10
In tackling a grievance, there is need forjudgment. tact and patience.
Most often, grievances arise from
*
misunderstanding,
* misinterpretation, or
* discrimination.
Problem people
There will be problem people.
Problem people may be
*
*
*
*
They do not
carry out their duties satisfactorily.
non co-operative,
poor performers,
those who break the rules and regulations; or
those with poor behaviour.
Recognize such people and deal with them effectively. It i
is not simple.
understand why these people behave in the manner they do
Try' to
While dealing with problem people.
*
control your emotions (not easy but can be developed),
give importance to the individual’s feelings.
*
, learn the other side of the story;
*
apply rules uniformly and consistently.
*
19
Si
Performance appraisal
There is need to have information regarding the performance of the personnel workin<>
in the hospital. This can be achieved by a system of performance appraisal.
Objectives of appraisal
Administrative
.
.
•
.
Provide data regarding merit, incentives, rewards,.promotion etc
weed out low performers and improve the performance
suitability for different kinds of assignments
manpower planning and organizational development
Performance improvement
Employee’s objectives
♦
♦
.
Employee gets a feedback
Employee develops role clarity with regard to the job
Employee is able to clarify his/her career plan in the organization
Appraiser's objectives
.
.
How well has the objectives of the institution been communicated to the
employee and facilities provided.
Review of the work done by and with this employee.
The appraiser
♦
Superiors
♦
♦
Peers
Self appraisal.
Formats for appraisal
There are many formats available. Among them ;
' *
are the free written ratings, forced
distribution technique, the ranking methods, the graphic ratine scale
- . ----- o ----- , the critical
incident method, the forced choice rating method,
...
the behaviorally anchored rating
scale and appraisal by objective.
To get the best out of the appraisals, it is
necessary to nave appraisal interview. It is
necessary to have appraisal interview. IIt must be carried
out with the objective of
helping the employee carry out his/her duties better.
20
management
iN A CLINICAL
setting
- POLLOWING FOUR aspects.
such
PF DRUGS
AS PHC/PHU
and
IS
DEALT
in
TPF
the
rr)''
1. INDENTING AND PURCHASING G"
OF DRUGS AND DRESSINGS AND C'-’-v'CALS
2) ABC ;ANALYSIS/
CLASSIFICATION
--I OF DRUGS.
3) STORAGE
-- : AND maintenance INCLUDING
BIN CARDS.
4) PROCURING OF drugs FROM
g.m.s. AND SUb
HOSPITALS under k.h.s.d.p
• SCHEME
"
STORES AT district
WE SHOULD KNOW SOME FACTS IN
brief.
WHAT IS MEANT' BY "DRUGS" ?
^•ny medicine :for internal
or external
use of human beings or
als and any substance
anim
intended to be
used for -or ir. the
diagnosis, treatment,
mitigation of
pain or Ptevention
disease or disorder in
or any
human beings includi
on human body- for
ng preparaions applied'
the purpose
of
repelling insects
mosquitoes is a drug.
like
A drug may also be defined
as a combination
animal or chemical origin.
of vegetabi.^ or
Drugs affect living
a drug is administered,
protoplasm.
When
it acts on the
cells and certain effects
are produced.
However there are certain
mechanism of action differs Slicff substances used as drug but the
as. "
1- Mechanical effect Example •Plasma volume
expanders LOMCDEX,
2) Physical effect
Haemaccel and
on
gut
Parafin.
• - (a) causing.changes in
pressure
diuretic
cathartic
sulphate.
(b)
liquid
Osmotic
example
Osmetic
like
urea
and
like
magnesium
By
rtbsorption/adsororion
example bej
ng Kaolin Powder and
Carbochol the activated charcoal
which is
used to remove gases
and toxins from intestines.
(c) Product ion
of lethal rays:Example:- Radio-active
isotopes
used in Radio
-diagnosis and
Radiothe tapy for
malignancy.
3
*
3) Chemical Effect:-
Example
Aluminium
,
Hydroxide
and Magnesium Carbonate used to
Neutralise
aciditv
Acid-Peptic disorders.
Most
is the effect of
drugs
cells and without causing harm to
the
physiology and give beneficial effect.
4)
Important
in
which
penetrate
cells
alter
NOW REGARDING SOME FACTS WHICH YOU SHOULD
KNQW
about drugs for purpose of
indenting/procuring r
NOMENCLATURE OF DRUGS.
that
the
ohei-x
is
the
A DRUG HAS THREE NAMES:1) PHARMACOLOGICAL NAME which is
usually unr-wieldy
and complex
ee-2 -Chloro-10-Pheno thiazine
Hydrochloride.
2) APPROVED NAME
is the name given by the General
Medical Council and it should be
used
by
referring
the
to
Doctors
the
while
drug
Eg.
Chlorpromazine.
3) PROPRIETARY NAME
it is the name assigned to the
drug by the manufacturer
Eg.LARGACTlL.
Second example
.Pharmacological Name:—4—hydroxy
acetanilide
Phenol.
“P-acetanido
Approved Name:- Paracetamol
Proprietors/
Name:-
CROCIN,CALPOL,FEBRIL etc.
It is also very
following aspects
important
1) Vital drugs
2) Essential drugs.
3) DesirabTe drugs
4) Life Saving Drugs.
to
categorise
the
dregs
in
the
will be dealt
category dtugs
detail list of
A
that primary life saving/
have
to
see
Medical Officers
later
stocked always.
essential drugs are
knowing the most
..vital &
make effort i n
to
Medical Officer has
of his
A
diseases in the area
effecting or occuring
of
^commonly
studying the utility
can
judge
by
This he
judg
Medicine
PHC/lnsticution.
OPD register or
bv
perusing
last 3 years
drugs fover
in indenting
Stock Boo*’ -This will help him
to
leads
s y s t ern.
drug
of
roanageraent
in
Snefficiency
imbalance in health care.
the
above
that he
to be improved so
have
The,skills
SKixx5 of
ux the Pharmacist
’
management as to
service by proper
able to deliver the
time in.
will be
available at the -right
the right drugs will be
see that
manner to the right patient.
the right
inventory is oz
maintenance of drug
for
The responsibility
the
pharmacist alone.
management depends’ on:The effective drug
— ” maintenance.
--- -14- -inventory
— of drugs •
facilities for storage
2) Basic :-in how much/ and when
and analysis helps
of
survey
distribution/
3) Importance
organising the
of
drugs,
regardingj procurement
the wastage of drugumovements to prevent
stock i-Establishing the
the accounting system,
procurement.
4)
listed g°r
the drugs of absolute need are
5) Only
is well specified,
is
procurement
6) Quality
of
source
the
reliability
of
7)
General
drug in the Institution should be
identifiedreaction to any
inform to the concerned proper
8) Any adverse
registered /recorded and he should
higher authority.
the
the categories of
The following
of
to
the
Department
pertaining
Karnataka/
Education DepartmentF.VJ. Services and of Medical
are
Hospitals
in
Healch -
aHQ
^0
1) 'Ial°r Hospit
2)
°iSt- HoSpit
ais
ais
3) General
Hosp
~7als/CHC
4) Tal^k Levsl
PHC'S
5) T.B.
'
Centres
51 ehc
7) P-H.U
8) Sui>centre
s
9) NLcC/nlCu
10)
SEt centr e
11) Dental
12) Ed
13) TB Sanitoria
16 nos.
"
27
'
242 ”
99 rr
'
27 M
1601 "
600 ••
8193 ”
3 i »»
6 77 ”
150 "
4 nos.
4
Can*be done
-OBASSlpj
in tv/o
Tvays . _
OF
1) AoCordin
S to the
2) Accordin
systems
the drugs
7 to
their
S3zniptonis Of
act on.
action/effect
ailni.ent.
on
pa-ticuiar
I’ ciassifi
CatiOn
The foliowing
~ Dru ■^-Sotin^
ar©
the
system.
method of
^^Mzsterns.
analysis
7\)£^2s_acting
and
°f the drUgs
th^ -as
l) Antacids
._’ CN
'—:
2; Gastrointes-,Alud
—^ox, Di9ene
etc. Suinal
etc.
sedati ves
••-Eg. Bus
3Z Laxati
CoPan,
Ves and
-Pid
l^oricants - p
Drugs
actin? on
CreTOaffin,
5Antidia^rhoeais
D'^colax.
6) Enz
iW ■•- Eg.
yn,es' dlgesti^
DePsndair
PrQCtosedyi.
7) Hepat
~
Ur
oxone
,
’ E?- Digepi
° ~ Hilary
lomofen.
UgS
Jet ex- NeO;'PePtin
e Vita2yme
f2)ORU,
°sitoi
'2S_ACTiNp
' Me '-'Olin.
1) ^rdiac diSr ^—^EDlOyz
2) Cor°nary Vasorders TV'
Eg- °igoxin^STE^j.
"
3) Peripheral Viators '
£?- Nitro?lyc
vasodialat
4) Anti
Coa?ulants . .
ES- Ariidir etin.
/Thr OltboSpin
and Aati
Thrombotics and Complanina
Hepartn.
5)
‘‘aemoStatiCs
* ~'e9 • StrePto
Co. Bofcr_
kinase
* °Pase, Siochr
“onio _
the
(3) DRUGS ACTIkG-Qk
CENTRAL
NERvous SYSTEM.
1) AnalgeSics^77nt
._
pyretics .-- ea
..
9‘ aracetan,ol ,Metacin
2)
Sedative
and
1—anquillisers : - >„
Eg.
mg. ..diazepam Sag, 10mg.
Targactil
10mg,25
3) Anti-Emetics •
<>
» C-N.S. StinillMts
“'-“l.«.taclc,rpriae Bel
o
"O“aCbitO”e 30"S.60(.g.,Di„epan
400mg.
71 »ntl-depr..aant
8) Hypnotic
Ec n
^.^Ptyline hcl.
I0|flg,25 mg.
'■ Gara-nal 30mg.,60mg.
(4) MOSCULO —
; S^SELETAL disorders
Non- Ste.lodal
anti-inflamato
. ibuprofen, Dichlof.enac.
drugs-: (2) Muscle-r elaxants:'
Eg. Valethamate bromide
3) Ru'Seficients :
d mgEpidosin
Eg. Methyl Salicylate.
4) Neuro-muscular
drugs
eg. piroxicam
0.5%
ec.
(5)HORMONES.
1) Gonadal Harmone •—
derivatives, Testosterone Eg- Oestr.agen.. derivatives,
Progesterone
2) Oral Contraceptives - c^^ivatives.
e9’’ OVRAL,Ovulen etc.
3-) Cortico- steroids
eS- Betamethasone,rDexametl-jasone.
4) Hypogltycaemics
eg- OraJ. and Injectables
5mg. (b) Chlorpropamide,
(^JGlibenclamide
/(c) Insulin.
5) Thyroid
and
Thyroid and Anti-th
ci-Thyroid drugs
Eg. Thyroxine
Carbimazole 5 mg.
O.lmg ana
--------- “ -
-
( 5) ..GENIJO - URIKApy
SYSTEM.
1)
Diuretics
and
Anti-Diuretics
(b) Acetazolamide
e9-(a)frusemide
20mg.
250mg. (c) aDH
2) Urinary Anti-infectives
and Antispasmodics Acid (b) Pyridium, (c)Norfl
E9-(a) Nalidixic
oxacin,(d)
Buscopan.
3) Drugs Acting On
the
Uterus :
e9-(a)Oxytocin (b)Methyl
ergometrine tartarate.
4) Spermicidal Cen--nr.
n--aceptives
Eg. Foam
Tablets.
i
i f
(7)RESPIRATORY system
1) Broncho- spasm relaxants
eg. Ephedrine,
Theophylline.
2) Expectorants, Cough suppressants.
3) Respiratory stimulants:- Eg. Nikethamide.
(S)
EAR, NOSE AND THROAT}
Dissolving Ear wax.
Decongestants
/Analgesic
Drops,
(9)EYE
1) Anti-mfective preparation.
2)
Anti-inflamatory
-Eg-Neosporin-H drops.
and
Anti-Alergic
preparations.:
(10)SKIN
1) Soothing and Protective.- Eg. oint^L
SJ^Toprcal Anti-Funcal drugs -3) Acne
'
9 • Eg. Miconozole Nitrate.
4) Pigmentation disorder:e9- Psoralin.
(11) INFECTION and infestations
1) Antibiotics
eg. All Antibiotics both broad
spectrum and
narrow spectrum.
2) Sulphaderivatives
3) Anti-Tubercular drugs
Eg. Streptomycin Sulphate 0.75gm and
Ig’ni.,
Refampicin
200
■
400mg.,Eth^mbutol,iSonia2ide
100mg/300mg.
4) Anti-fungals :■
Eg. Ketocanazol , Griseofulvig,
5) Anti-Amoebics • • eg. Tinidazole,
Metrogyl.
6) Anti-Malarial; Eg. Chloro
quinphos, Amodia aUzine Hcl.
7) Anthelminthics drugs
eg- Albendazole , Bephenium.
8) Antiviral
5) 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
t Astemizole.
A??
14)M<AESTHETICS AGEMTS AND INFUSIONS
1)
Anaesthetics
agents
■-
Ether,Halothane,Lignocaine , thiopentone.
2) Infusions (i.v fiuids):_ eg. Dextrose
Expanders:- Eg.Lomcdex.
1) PIAGNOSTJC
AGEMTS :-
5*
Nitrous
Oxide t
and
Plasma
10% ,
Eg. Uro-Miro 420, Urographin.
10J ^=TABOLIC and
and MISCELLANEOUS:1) Chemotherapuetic drugs
Eg. Endexam.
Drug
dependence
-treatment
Eg.Disulfiram 250
mg.
3) Poisoning
eg. Injection PAM.
for
chronic
^omc
•alcoholism
17)DRESSINGS AND appliances
-• classification II.
ANALYSIS OF THE DRUGS
The other’method of classification
of the drugs is as follows
depending on <drug action.
1) Anti-pyretics
2)
Paracetamol tab.,Aspirin.
Analgesic
a)Diclofenac
sodium, ibuprofen (b)ketolac
3) Antacids
4) Anti-Diarrhoeal
5) Ant1-Amoebics
6) Anti-Allergics
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
18) Vitamins
20) Anaesthetics :— ocal
21) Eye/Ear/Nos a drops
mcting
and general,
r
n
22) Drugs Acting on the Uterus
23) Infusion Fluids
MditIves
24) Mineral,,
25) A„ti.diabetic5;. Qral and
S^ORE-STOCK MAINTAINING
The
store.
1)
following
procedure.
I
four
registers
should
be
ma j. n t a i n e d
in
the
DAY EOOK:-
For monitoring the
receipt of any item prior
entry in to the
to
stock book.
2)STOCK REGISTER:-
Showing the source of
procurement and date of
receipt, issue and balance
on hand-.
3)DATE OF EXPIRY
REGISTERrsould be maintained
compulsarily to keep advance track
the drugs due to expire,
of
This register should be monitored
MOH for every two months.
by
This
4)ADVERSE REACTION REGISTER:MOH
PHC,
should record
adverse reaction of
any
any drug either in OPD
ojt in-patient.
matter of adverse
This
reaction should be brought to the notice
/DHO'.
of TMO
BIN-CARD
This
will
help
in
knowing on the; spot
the exact stock
particular drug and the
pattern of expenditure,
Date of expiry of drug ,
source of procurement.
Details on Bin-Card;-
position of a
Date of Expiry of the
drug should be
written
should attest the issue
and balance columns.
Action taken
expiry:-
to
dispose
of
the
drugs
which
in Red
are
ink. • mo
nearinc
date
The Bin-card is like
a mirror which 5ives complete information
a drug.
of
PROCEDURE FOR DISPOSAL OF NEARING DATE
OF expiry DRUGS;Any drug which has got six months time before the
before
d = te of
expiry
and which is not being utilised
in your institutions
should be informed to TMO in .
monthly meetings, so that TMO can
take action ho redistribute the drug
to other needy institutions.
i
This procedure should be adopted
regularly i.n every monthly
meeting till the
rug is
is shifted
the d
drug
at least 3 months before the
date of expiry so
so that
that other institution
can make use of or
replacement c^ri be made.
BUDGET ALLOCATION:-
Know your institutions budget allocation
ear
marked
for drugs
from
G.M.S.
and
from
should be clearly understood.
The total amount
District Sub-Store
'(flease see ;ANNEXURE NO. I.)
CIRCULATION OFLAVAILABLE DRUGS IN THE
INSTITUTIONS
The list of Drugs available in
the institution should be
circulated among the other Doctors
of the Institutions
for
effective health care delivery system.
statement
SHOWING THE VITAL ESSENTIAL
and desirable and life —
. ^SAVING DRUGS IS AS FOLLOWS.
(Please see ANNEXURE NO.II)
zBefore concluding it is suggested to have
an emergency drug
kit which should contain the
following :
1) Injection Adrenaline
2) Injection Hydro <
cortisone/Betamethasone/Dexamethasone
3) Injection Oeriphylline/Amino
-- > Phylline.
4) Injection Diazepam.
5) Injection C.P.m.
6) Injection Dichlofenac
7) Injection Fortwin
8) I.V. Dextrose 5% /DNS /Linge
r Lactate.
9) Injection Ranitidine '
10) Injection Botrooase
15)injectiou baralgan
11) Injection Atropine.
16) Injection Metachlorpropamide
12) I.V.Manitol
h
13) Injection P . A.: ■.
14) Injection ASV
Scap-vei n set.
I.V.Cannula
+
I.v.Drip
set
+
I
I 'b
ANNEXURE NO. I.
BUDGET ALLOTMENT FOR DRUGS AND CHEMICALS
10 0%
Rs
PHU ’ s
30,000-00(GMS)
PHC ' s
50,000-00
G.H or C.H.C’s 3,00,000-00
C.H.C’s &
2,00,000-00
40%
Rs
Rs
20,000-00
30,000-00
1,20,000-00
1,80,000-00
80,000-00
1,20,000-00
Tq.leve^l PHC
SUB-CENTRES
60%
5,000-00
each
SET CENTRES
4,000-00
Each
Dental Package
10,000-00
Each
NLCC
MLCU
75,000-00
30,000-00
45,000-00
30,000-00
12,000-00
18,000-00
P.T.O.
AH the urugs
be lis-^
drugs have
have to
1
-Ton. th. StocR „gi„,rs
.b‘
■ u
help of store
Pharmacist
. re9isters
5 =-ers.. All the drugs to be
order of thexr Annual Consumption Vaiue.
arranged
in
a
On
descending
drugs are to be classified into A3C categories. tha basis of total cost
0-\
TABLE 1. ABC Analysis of
the Drugs during 1995-95
Items
Category
Annual Consumption
Total number
A
86
B
C
125
331
Total
aH items
16
23
61
542
100
value'in as.
5137533.38
1467866.36
733333.40
10
7333334.14
100
But However• VED
Analysis is better than ABC
' E = Essential , 0’
Analysis.
= Desirable.
Here you can see the
top ten items
Hospital.
TABLE 2.
Items
% of total
Consumption
70
20
v
Vital,
expend!ture of a particular
The Description of
Top ten items.
Name of the item
Percentage of
Total budget
1
3
Tab Erythromycin 250 mg
Cap ampicillin 250 mg
10.7
Tab cotrimoxazole Plain
4
7
6
10
iab Baralgan
Cap Tetracyclines
Tab Nidazest 5 rag
(Ethynyi Oestradiol)
6.8
Dextrose 5^
Cap amclox
6.8
Tab desferol
Cap Raricao
Total
24.3
^4
TABLE NO.3. VED Analysis
Category of Drugs
No. of Drugs
of total Drugs
V: Vital
E: Essential
D: Desirable
Explain About Lead Time :-
116
172
254
21
32
47
Internal & External
5
R ECRUITMENT
THE KCS (GENERAL RECRUITMENT RULES, 197/)
- Sn. P. Raraanathan
A) APPLICATION:
APPLICABLE (RULE 1 (3) (A)
1) To all Civil Services and posts to which there are no
special
rules.
2) 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.
establishment.
4) To
2 _ Work-charged
.- B) METHODS OF
RECRUITMENT:-
’ j. The rules give the different
This is the core of the rules
methods of-reoruitment and the incidental provisions.
Basic methods of
recruitment
(I) Direct recruitment (R-3)
(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).
Consultant. DPAR.
Exceptional methods
of recruitment
1) Re-employment
- (R-15 (I) (a))
2) Contract (R-15(l)(b)
3) Transfer (R-16)
4) Deputation (R-16)
d"}£ct«£c
"■’nsfo0^
''PPttr
nt^enr 0(h
.
hv
/s din«cIrctPromPP» n.
cn"ment
nerearei-^Msofd.
<0 by com
°f d,r«> rec7uitment>
.
!“>bys^ZZZTeZ"‘;^
PROc^Of
FAPpomTM
E.\'T
COtTipehf,.
‘mm^KU":4^n,y 0;,h the
IfL
{l^)).
-
of ^s5re'tection- after aiv
b nF
°fme^
^asis of prePared
SUcfi an
dete^ned bv11* adequare
(IXb)).
' ,lK «'«r.ns
<2 > ^OMOTlon.,
Def;nitiOn.- .■
^nftment of a C
R0St/Srade/c^
,b5!— z
ass Of serv/
a Go,Vern^ent Sen
Oa^
'orn a
'oracfe/c/.'ass of
- p»st. i7’n;ft
^‘^Sriv^
'nS^ri
^rt,lK^ar!
!962SC36)
tW° m^ods:.
J Protnoti0n
selection
theb^ofSe ■
'■ROcWe«£
'mSr,t ^le 3(I)
,e,,> sefe„,„„
ctIOn
®
(^ole^
(“) merit i
t0 Parity
ACRS.'
CZbsrK^
^s’ Pers.
ss,er
ervice r^r>
SR
.
‘Scords -
KI
(iii) Seniority brings within the zone of consideration only
(provision to Rule 3(3)(a)).
Union of India -V/s.-Snvatsava - 1979 (2) SLR 11.6 SC)
Zone of consideration is 2n + 4 where ‘n’ is the number ot
vacancies.
(iv) Seniority is nor the sole criterion but it counts when two
or more persons are ot equal merit.
(N.K.Panda- Vs-Union of India - 1977 (2) SLR 589
(Orissa)
(V) This method or provision is limited to the post of Heads
of the Departments and Additional Heads of the
Departments in equivalent grade - Rule 3(2)(a)
41
If on the basis of seniority - cum - merit.
class of posts - on the basis of
(i) If from one cadre or
Rule
4 (1) of the Seniority Rules.
inter-se seniority - P
(ii) If from several cadres; or classes of posts of the same
grade by the length of service - Ruie 4 (2) of the
Seniority Rules.
Note:- This provision prevails where the C&R rules are
silent and does not provide a ratio).
(iii) If from several cadres or classes of posts of different
kinds by the order in which the names are arranged by
the appointing authority - Rule 4 (m) of Seniority ru es (iv) This method of promotion is apphcaole to all posts
other than HOD and AHODs - Rule 3(2)(b).
(3) RE-EMPLOYMENT:(1) Restricted to appointment of retired
servants of the State Government, Central Govt., and
other State Governments.
(2) Terms and conditions are unilateral - one
one siaeu
determined by Government under rules.
(3) Period of re-employment as may be necessary an
determined by the Government. There ts no limitation Rule 15 (l)(a)
3
Pd0
14
'0^-
(Note. - Extension of service in
be granted beyond
end,t
y-arS}-Rule(15(n) ofKGS)
(4) CONTRACT-differ, fromr
< > my eligible Md suitablere>emp;oyrTlenf
- P^on can be appointed.
(b) duration of the
beyond five years. appointment is normally ng*
(OiV[ No. DP.^R 15SDS85. Dated
June
(5) TRANSFER AN
D DEPUTATION.-.
0) Government may aoDoint r
anY other State. This
deputation For'
deputatton equivalence of aL" SUCh transfer or
’
.J e is not
(«t) Government may aJsn *
,S not "ecessarv
o'ne
°
rder
Nation, from one seX0^ tran^r or
othT :° °the—e
t0 other wtthin State
?ueasons to be r
i. writing.
(b) The post in -- recorded m
which th.e official is° ■■
and the r
- to i ’
working
Post
which he has to be
^ansferredJ <or deputed
-J should be in an
equivalent grade.
(c)' The
..-e official should
be capable of
discharging
the duties
°P the post to
which he U
transferred °r deputed.
(w) Government mav ,
an official who is
ed
for
the post
r - which he
s adding or to
another
post
where
his
can be utilised.
Such appointments. --J services
i-Ua.0'"1
(a) cannot be
a lower
official eonsent to it or P°st unless the
(b)to a higher post L-iess there is
no
equivalent post.
Government may similarly appoint an official whose
service is temporary incapacitated.
Such an
appointment can be only for the durat.on of the
temporary incapacitation.
(6) Government may appoint by deputauon of a person to
any Group-A post in the State Civil Slices. If such a
person is:-
(a) In the service of any Universitv in India'
(b) In an equivalent grade; and
(c) in possession of speacialised qualification;
»
Period of deputation - net exceeding five years.
MATTERS RELATING TO
DIRECT RECRUITMENT
D) DISQUALIFICATION:
It is a negative provision. The qualification is, not to
possess the disqualifications listed by the rules.
The disqualifications are.(1) Not being:(a) a citizen of India, or
_(b) a subject of Nepal, or' :
(c) a subject of Bhutan, or
(d) a Tibetian refugee, or
(e) a person of Indian origin migrated from
Pakistan, Burma, Sri Lanka and East
African Countries of Kenya, Uganda,
Tanzania, Zambia, Malawi, Zaire,
Ethiopia and Vietnam;
(2) a man having more than one wife living;
(3) a woman married to a man already having a
wife;
(Govt, may exempt the operation of this rule in
special cases).
(4) Persons attempting extraneous support for
appointment;
ic>3
(5) applicants in Govt, employment not making the
application through proper cnannel (Exception
Local Candidates);
(6) for appointment as peon-not passing standard
examination and not expressing willingness to
serve as Home Guards;
(2) persons associated with unlawful organisation
(8) Persons associated with activities such as
• subversion of the Constitution;
• Organised breach cr law involving
violence;
• causing prejudice to the interests of
sovereignty, integrity or security of the
State;
• promoting disharmony among different
sections of the people;
J
^0
(9) persons dismissed from Central or fState Govt. Services;
(10) persons permanently debarred by thei UPSC or any
State PSC.
(11) persons convicted of an offence involving moral
turpitude shall not be appointed unless all
the
circumstances are reviewed and their suitability tested.
(12) persons temporarily debarred by the UPSC or State
PSC’s shall not be appointed unless all the
circumstances are reviewed and their suitability tested.
- Rule 5.
2) AGE
(1) MINIMUM
18
maximum
38 - SCs/STs/Category II
36 - OBCs
33 - GM ’
Age to be reckoned with reference to the last date fixed for the
receipt of applications or a date specified bv 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 Classes, then these upper age
limits will prevail - Rule 6(2)
(j) 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 aye limits
50
(a) Relaxation:In the case of repatriates from East Pakistan (Bangladesh)
Burma, Ceylon (Sn Lanka), East African Countries (Kenva
Uganda, Tanzania, Zambia, Malabi, Zaire. Ethiopia and Vietnam,
the upper age limit shall be relaxed;
I (rS
(i) by 3 years for recruitment through competitive
examination,
(ii) upto 45 years for all other recruitments;
and
this shall be further relaxed by 5 years for SCs and Sts
among them.
(b) Enhancement:
(1) by 10 years in the cases of a candidate;
i)
who is or was holding a post under the
Government or a local authority or a
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
iii) who is a widow;
iv) who was a bonded labourer.
(2 ) by 5 years in the case of a candidate;
i) for appointment to a Group-B post on the
personnel establishment of a LMinister, -Minister
of State or a Deputy Minister/ coterminus with
the tenure of the Minister;
ii) who is or was holding a post under the census
organisation. (If the number of years of service
is less than 5 years then by the number of years
of service);
(3) by the number of years of service in the case of a
candididate;
i) who is an ex-serviceman + 3 years;
ii) who is a rleased NCC full time Cadet Instructor;
iii) who is or was a Village Group Inspector under
Rural Industrialisation scheme;
iv) who is or was a member of the Staff of former
Maharaja of Mysore.
(Rule 6 (3Xb)) .
IS
/z>6
Application through proper channel:
Persons already in Government sen/ice should make the
application through the
appointing authority.
t his condition is not applicable to Local Candidates
(Rule 1 1)
FEE
0 As prescribed by the PSC or other recruiting a^enrv in
Government in respect of application and examination?
i •
• ,
C0nsultatl0n Wlth
ii) as prescribed by Government in respect of medical examination
Exemption of fee:
i) Total exemption in respect of SCs/STs/Categorv-I
u) This exemption in respect of displaced Goldsmiths-
(Rule - 13)
Suitability and Character:
i) to be tested by detailed verification int he
case of Group A &B;
ii) to be tested on the basis of certificates in
the case of Group C&D
Physical Fitness:
>)
(Rule-19)
detailed examination by a medical Board in respect of Groun
’ S
„o. be,o„
- (Rule-12)
Joining Time:
io PoiXiX
application made within time-
3 T""*1 p0!I;
necessary on
(Rule - 18)
\0
Probation:
All appointments by Direct Recruitment shall be on probation for such period, not
being less than two years.
(Rule - 19)
Misconduct:
A candidate producing falsified documents or using unfair means in connection
with his recruitment is liable to;
i) criminal prosecution;
ii) disciplinary action;
in) debar permanently or temporarily by the Commission from admission to an
examination or interview;
iv) debar from employment by Government.
Physically Handicapped.
Wherever there is an element of direct
Recruitment 10% of the vacancies available for such
direct recruitment on any occasion shall be
earmarked for ex-servicemen, 5% for physically
handicapped persons, and 30% for women.
This is a reservation under Article 16 (1) of the
Constitution^ of India. This is called horizontal
reservation whereas reservation under Article 16(4)
of the Constitution of India is called vertical
reservation. The horizontal reservation has to be
within the vertical reservation and the overall
reservation should not exceed 50%
For this purpose 10% of the vacancies for Exservicemen, 5% of the vacancies for physically
handicapped and 30% of the vacancies for women
shall be set apart in each of.the categories of general,
merit, scheduled castes, scheduled tribes and in each
of the categories among other backward classes
identified under Article 16 (4)
(Rule -9 and 3B)
Officiation: - All appointments by promotion shall
be on officiating basis.
The period of officiation shall be one year unless
otherwise prescribed in the C&R rules.
Q,
1-3
This period of officiation rmay be extended by
another year by appointing authority,
........... No further
extension is permissible.
The period ot officiation may be valued if the
official has already discharged for the period of one
year duties of the post to which he is promoted.
The period of officiation may be reduced bv such
period not exceeding the period during which the
official has already discharged if anv. the duties of
such post.
On the expiry of the period of officiation either it has
to be declared as satisfactorily completed or the
official reverted.
After declaration of period of officiation the offic.al
may be confirmed at the earliest available
opportunity.
INSTRUCTION ON PROMOTION:No person retained in service after the date of
superannuation shall be promoted to a higher post.
-
COMMON PROVISIONS:
This restriction does not
apply to
officials who
who have
have
not apply
to officials
been retained in service
the last
last day
day of
—e upto
upto the
of the
the
month in which they have attained the age of
superannuation,] in accordance with rule 95 (a) of the
KCSRs.
(Rule -7)
1) reservation:?
Keservation
Reservation:-/ Reservation for Scheduled
Castes/Scheduled Tribes and other Backward
classes shall be made to such extent and in such
manner as may be specified by Govt, under Article
16 (4) of the Constitution.
(Rule - 8)
Government have been issuing orders under Article
16 (4) from time to time and at the moment orders
is5ued on 20-6-1995 and connected orders in respect
ot direct recrutiment and orders- -----issued1 on 27.4.1978
and the connected orders in respect of promotion
——s
are in force.
The Pc|icy of reservation
is not
applicable to other methods of recruitments.
2) Appointment by
irect recruitment or by
promotion;i) a vacancy identified for promotion may
be filled up by direct recruitment if no
eligible person is available for promotion,
ii) a
vacancy
identified
for
direct
recruitment may be filled up by
promotion ’when such vacancy is not
likely to last for more than one year;
PROBATION/OFFICIATION
No person who has nor completed the period of
probation or cfficiation, as the case may be
satisfactorily, shall be eligible for promotion.
-Second provision to rule 3 (1)
♦ •
1»
7o
Seniority
i.
Application
The Seniority Rules, 1957
are applicable to all Government servants except to -
(a) local candidates (Rule -1A)
(b). allottees in determining their initial seniority. (Their seniority shall be determined
in accordance with section
<
115 of the State Re-organization Act, 1956 and the
orders issued thereof).
4)
I
IL Principles of Seniority
What is Seniority ?
Persons appointed earlier either by direct recruitment or by promotion in accordance
with the rules of recruitment are senior to those appointed subsequently. In other
words appointees of one occasion are senior to the appointees of the next or
subsequent occasion/s if it is within the frame work of rules of recruitment and this is
what is known in service jurisprudence as seniority according to continuous length of
service in the cadre or grade.
(G.S. Lamba V/s Union of India)
1985(1) SLR 687 SC)
(1) Appointments can be made on a permanent (substantive) basis or on a temporary
(officiating) basis.
(2) Officiating appointment can be made substantive by the process of confirmation.
An official can be confirmed when the following conditions are satisfied :
(i) availability of a clear vacancy against a permanent post;
(ii) the period of probation / officiation of the official is declared to have been
. completed satisfactorily ;
(iii) the official has passed the prescribed examination, if any, to the cadre /
post;
(iv) the official is the senior most eligible person in accordance with the
seniority list.- -- (3) An official appointed on substantive basis is senior to all officials appointed on
officiating basis in the same cadre of service or class of posts immaterial of the
length of service.
Rule 2(a)
(B.N. Nagarajan V/s State of Karnataka)
(197992) SLR 116 SC)
(4) Amongst the officials appointed substantively the interse seniority is to be
determined according to the dates of confirmation but if it is the same, on the basis
of their interse seniority while officiating in the same grade and if not on the basis
of their interse seniority in the lower grade
(Rule 2(f)
(5) Amongst the officials appointed on officiating basis their interse seniority is to be
determined on the basis of officiation in the same grade and if it is the same, on the
basis of officiation in the lower grade.
(Rule 2(c)
(N.K. Chauhan V/s.State of Gujarat)
(AIR 1977 SC 251)
!J
•I
HI. Seniority Between Direct Recruits
and Promotees
(1) A factor to be taken mto account while determmmg the seniority in accordance
with these rules in the proporti
. ' - '°n °r th! qU0ta Prescr:bed for d.rect recruitment and
promotion in a cadre in the Cadre and Recruitment Rules
(2) Direct recruitment and promotion are possible only by the methods and
procedure prescribed in the rules of recruitment.
(V.B. Badami V/s State of Karnataka)
(IR 1980 SC 156)
(->) When there is a quota, the quota cannot be altered
according to the exigencies
of the situation.
(S.C. Jaisingani V/s Union of India
1957(2) SCR 703 SC)
-41
(V.B. Badami V/s State of Karnatak.a
AIR 1980 SC 156)
(4) imeX0”™^' ” “““ off ro'nmio"al
-hoosh not illenal are
irregular. The excess promotees have to be absorbed in
“
within their quota.
absorbed in subsequent vacancies
(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
i respect of direct recruits also
oimnar
(o) For the purpose of calculating the quota between the direct recruits and
promotees the penod wh.ch forms a block is the penod from the date of Cadm
the dam^Xne XT
°f
rec™ment- Thereafter from
However if thlt
t0 the daIe
next direct recruitment,
nowever, it there is an amendment to the Cadr« and
u
oil
period is from rhe dare of Cadre and ReenairmeV
T
' "
date of amendment and then from the date of ami d
to the
direct recruitment.
amendment to the date of next
(V.B. Badami V/s State of Karnatak a
AIR 1980 SC 156)
(2) to (5) above are covered by the Official Memorandum dated 5-7-1976.
—...
Gonal
Badami’s case have been reiterated in
•
*
;
evolved
in
(6) The principles
f Karnataka
Bhimappa V/s State o
(AIR 1987 SC 2359)
Official
i
have been reiterated by the Government vide
Instrucuons also have
14_l2.1987
Memorandum No.DPAd<
r nf nromotees and direct recruits is the same the
•/>
—»*■ promot“s-
.
lRule J
41
'.5
TJ
i
'
■
IV- Seniority Ani0
;?:W
Promotion in
e ^rornotees
one of the
»raPPo,
ern Railway V/s Dnn
OUR J962 SC36)
■)
y /s Kangachari)
•V;.<
APPO'"I"’“lbypr0m°“0"'Sposs,bleb
<c-;
'y rwo methods, viz ■
p? f<Omot'cn on the basis
} r0m0tI0n
selection. of seniority cum
■rHerit; and
Theseniority,n these two cases hH
ases is determined
follows ’
1 aP)rorJOnOn£he basis Of sen,
nE0"””9'7™ anyonty-cum-.
one cadre
n the lower cadre
Orc/a«ofpSset'meh'’
POSK-,’^-«n,ortyinterse
R Promotion arPfOrClaSS OfPosts;
re
from
several
cadres
tbe order in
which the names are
“W*
by
fn consultation
™l> the P„W]C s
“"= ’tthori.y,
necessary, after
Mk"’S tao eo„si(iera,ro„ Commission,
“>"• Where sucb r.
.
made from ^ose cadres
—
“
order
in
’
• <”• olasses „fp0SB
Her
prom" consultation is
-c are to be
''2'^».ot,„„byse,ectio
(Rule 4(iii)
cne same time(Note ■ Now
•
D'9—ntsintbe^e-™etI. Heads
of
p nme.rLS and j01nt Hgads
raJ J •
Whethc-C poSn2rtehfrOm the name cadre or cl
Or c/asse;
fS^such6 coPOi?tinS
d*
Pubhc sLice c '°f
c
es or recrmtment.
.
any special order of
of^XXr the SOie Cnter,on- Jr Coun^ only where
miSS,On
(Rule IV)™"7 m
or more persons are
i
(^■K. Panda T '
V/s Union of Ind,,
a
<i977(2) SLR
oS9 (Orissa)
S'"'“"^™S!the0ffic,a,sw„hinth
i
eZ0ne0fcocsiderati0n
(Union of India V/s Srin-
1979 w SLR 724™X"
ZoK »f«ns,derati0„ ,
I
IS -X + 4 wherp Y •
X'!!,,l '"u’'l’ar„fvacanL
r
I':
V. Seniority Among the Direct Recruits
The appointing authority has to determine at the time of first appointment : Rule 5(i)
(i) Where the recruitment is through a competitive examination, in the order of
merit.
(Rule 5(i) (a))
(ii) When it is by selection it will be in the order of merit in consultation with the
selecting agency.
(Ru)e 5(i)(b)
(iii) When successful completion of a course of training is prescribed, on the basis
of the order of merit,
(a) at the examination, if an examination is held ;
(b) at the selection for training if no examination is held. (Rule 5(i)(c))
The above principles will apply when the selected candidates assume charge within
the specified period under rule 18 of the Karnataka Civil Services "(General
Recruit) Rules, 1977. otherwise it shall be determined from the date of assumption
of the charge of the post. (Rule 5(2)).
(3) Within the specified period date of joining the duty is immaterial for the purpose of
determination of seniority and the ranking remains the same.
Syed Shamim Ahmed V/s State of Rajasthan
1981(1) SLR 100 Rajasthan
• '1
//^
VI. Seniority on Appointment by Transfer
(1) When a person is appointed by transfer from
or.e Jass or grade of service co
another class or grade of service carrying the
sarr.^ scale of pay, his seniority has to
be determined :
~
(i) if the transfer is in public interest, with refere-re k c
class or grade from which he is transferred : "
St aPPointment to the
(ii) if the transfer is ar the request of the official -f >
of the gradation list of the class or grade of seTce to^hth%bOttOm
as on the date of transfer.
’
1 which he 1S transferred.
When determning the seniority of a person transferred in
•- ■
public
interest with
reference to his first appointment to'the class or
frorn wh- J. .
has to be placed at the appropriate place amon» t~he
L W'h,ch,ihe‘S transf^red he
>n the class or grade to which he is transferred asTn th a,CtUaIiy?olainS £he posts
sercority of the persons .heady promoted cannot be di^d Xte
"d
(2) Transfer does not mean fresh appointment,
administration cannot be held as discriminatory.
Transfer in the interest of
(S.E.R. V/s M.P. Ranga Reddy
1992 92) SLR 346 Cal).
(3) If the transfer is on irequest, then seniority has
to be assigned as on the date of
joining the Head quarters.
(R.N. Dhawan V/s Union of India
1981(1) SLR 855 Delhi).
(4) The seniority of the officers transferred from
e
Service, a civil service ofthe Union or a civil service 0^
eqmvalent.class or grade of service in the S aTcivil V"7 ° .
determined in accordance w,th para (1) above. (Rule k)
5
T t0
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 Divisionwise cadres being included in the State-wide cadre, or
(ii) preparation of a Division-wise list consequent upon posts included in the Districtwise cadres being included in the-division-wise cadre
it has to be done by taking into consideration the total length of continues service
in the district-wise or division-wise cadres, as the case may be. But when the length
of continuous service of persons in such cadres is equal then it has to be done°by
taking into consideration :
(a) where such persons are promoted from a lower cadre, their length of
continuous service in the lower cadre;
(b) where such persons are directly recruited to the district-wise/division-wise
cadres, on the basis of their relative age, the older in age being considered
senior to the younger (Rule 7A)
/(?
VIII. Removal of Difficulties
Cases i„ which difficult arise and are no, caltle of being determ.ned by the
apptaion of any of the provisions of these rules have to be determined bv the
appointing authority himself, in such manner as he diems tit, in consultation with the
Karnataka Public Service Commission (Rule 8)
IX. Preparation of Seniority Lists
The seniority list for each cadre of service or class ct post has to be prepared in
accordance with the provisions mentioned above. every year. (Rule 10(a))
(2) The seniority lists have to be prepared by :
(i) the Government has Gazetted cadres of service or classes of posts
(ii) the Head of Departments concerned for the non-Gazetted cadres or service
or classes of posts. The Government may also prepare the seniority lists for
non-Gazetred cadres ot service or classes of posts. (Rule 10(7))
(3) (i) Seniority is a condition of service, hence every official has a ri-ht to know it
the senionty lists are, therefore, required to be displayed on the notice board of
the office or are made avadable to the officials concerned fop reference If any
official desires a copy of the seniority list the same may be supplied to him on
Payment of a nominal price of fifty paise per copy. They need not be published
in the Official Gazette :
(Official Memorandum No.DPAR 62 SRR 76 dt.9-2-76 and
Circular NO.DPAR 25 SRR 85 dated 27-7-85).
(ii) the seniority lists should be invariably prepared as on January first and
published immediately.
(Official Memorandum No. DPAR45 SRR 80 dt. 29-9-1980)
(iii) the senionty lists prepared’ as on first of January ev^ year should be
published before the end of February of the year concerned unless such an
action is prevented by orders of stay of courts.
(Official Memorandum No.DPAR 45 SRR 84 dt.22-10-1984)
1^0
X. Seniority list for day to day operation in the event
of the existing list being quashed by the court:
Jo ^nd
S >
y
d
s" Su"der M“"l'y (»"'
Te or
d Lt’ ’T t" ord'r on 3-'-|9i9 “ ,h' efl'“ '!»■
pan or
o JJ K td
remld'll“d ™,d Ih“
Should be mmuioed ue.
« he b
Sf t' P“'
,0 told ,nd ™ p™™ti»s Should be made
on the basts of the .mpugoed tmal ISS list without obtaming the permission of
WkJUIl.
Si
,he “s'1 Courl of Mysore in the case of one Sri. Kyathevouda
if the S °| KS 1° 891 "C h°fdi96|.9’ TSed “ °rder °“ 26-8->9TO to the effect that
f the final ISS list <s quashed e.ther fully „r i„ pan :he said list
be
ded
in the ? ' s' ChT",S.?c L’ “ "7 adht'hiatration subject to the conditions that
■* on th, b. °
b
o l'a> racttfied getting the promotions would be reviewed
on the basis of such a rectified final ISS list.
JtGAn
dlr“”0"sIC»v'rn'™- toe issued clarifications O.M
ISsTb
t
t r 71
effK! ,hat ”
'vent of the final
nJl er, r f r,U^
"J”' f0'10^ f°r ‘a^S day to day administration
revmwed P S
m r
•''’“’h'6 whe™';P°" >he pron.ot.ons should be
s Sd
°0''""™"'?ave also clarified that in cases where there is
m
t°d
c't”?"'"' “‘"t S“1' direc,i°"s ” conditions will have
XL he 7, TP c
X ?k‘"S "y S"her ac,i°" a"d 'ho aotioo taken
should be in strict conformity with the directions of the court.
r
'■•
•
\>Y
■J->'
l
PROBATION
I (I) Probation:
a) The preliminary rime feted to dhow htness or un.frtness to surface.
b) A period ot trail.
(2) Probationer:
One who is on trail.
n The Karnataka Civi. Se^ce (Probation) Rules.
p 1977
Notihcation «5th » •
GazetteeDt:7th July, 1977.
sr5SS'S~‘=-S-PROBATION
IJJ.PERIOD OF
, Not to than two yean excluding th. extraordinaryr leave - Rule
leave
extended to the extent of extraordinary
2' XSXly theZa- of Rule
Rules of Recruitment is less than
- . - Rule 19(1)
in’the Rules of Recruitment is more than
4. If the period of probation presented
the provision in the Rules of Recruitment preYads. ....
two years then t .
p/.EXTENSION:
, Reasons for extending the period0“ ZXZ W).
’
than Government may extend by bam
?■
J prescribed period -«*«»» for departmental examination during the
4. ff the probationer has appeared
th)! penod of pro anon rs
^oZcZeZded by’he operation of the provision under nde
fails.
■’
•»''
v. R£d^CTZON;
S-Z../
hisa'One can recluce not
naS d,scharged the duties.
proba,iMer
™d ba"»S wfeb
- ’
the P°st to which he is n
!,
• >
^ceedintt ‘he
Theeff° P0!,'h'd“u'sof-~fe;M
2)
_
eQuiva/ent
P««ic=.CX»t'be morPcrthIS'°" “ ■ha'
' Rule 4(2)
ProvisiOn ithan- half th' ,n respect of hem C
ab—
(0 abovi
even
eeX^T Per,°d -J in e’ che reduction. in
ent,re prescribed
aspect of Item (ii
Period.
J’SX^7XdeorforKI'"Sa« °f Punjab. SLR
SLR 1983^) Sc]
V'- DECLARA
n as well as t
be h0[’d
,
TlOiV:
^eendoftbeprcscri|;ed/Kte
Part of the
post
.
y
Singh V/s
.0 coSXT'A?f b -
Probation it is ( • ■■
obligatoty on the
esu,,at"«yofthe
— Probationer
—■ to hold the
Oe"ir'd 10
Period of probation
Ma'"B»h,c(,canl,eIakMi
should be
-'nto consideration for arf- ■ -
I.
work and t '
^nnanneanbae .
II. passing of test/,
vn. d^SCHARGE;_
'"= PfObXet
° he per!Oa of probation.
5(w“’°"er “ "O' suitabl.
be alten
Consideration ord'schargi|g the probationer.
Performance and service r
II. not passmg the prescribedrecords’
I.
Matters
1 tests/exaniination
°tfler than Wfc which can
ke taken into
i
I
f
f -
J
I
I.
Attitude or tendency - example attempts made by a probationer to secure a job with
better prospect elsewhere (Case Law, TCM, Pillai V/s Technology Institute. Guindy AIR 1971 SC 181 1).
II. Behavious or conduct - example the conduct which is not in keeping with the status of
the Govt, Servants (Case Law: Kumar Chandra \7s 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.
Vin. DISCHARGE DURING THE PERIOD OF PROBATION:
A probationer can be discharged even during the period of probation on the grounds arising out of the conditions imposed by tmles/orders of appointment or on account of unsuitability - Rule 6.
Orders of appointment may be subject to certain other conditions like; Investigation of
antecedents or physical fitness or jsubject to legal proceedings pending in the Courts.
When these conditions are not satisfied by the Probationer he may be discharged during
the course of probation.
Unsuitability is another aspect on the basis of which the probatiioner can be discharged
even during the period of probation.
However, when discharging person under rale 6 an appointing authority other then
Government should obtain the approval of the next higher authority. This is to avoid
prejudice resulting in malafides.
Recourse to rule 6 cannot be had when misconduct is alleged. If misconduct is alleged it
amounts to removal or dismissal within the meaning of Article 311 and hence the o'rders
passed have to be in conformity with the Article 3U(2Xi.e., recourse should be had to
CCA Rules and not to rule 6 of the Probation Rules - Ref. Rule 7 and also the Circular
No......................... Dt:................................ ).
(Case Law: Anup Jaishwal V/s GOI, SLR 1984 SC 426).
LX. GENERAL ASPECTS OF DECLARATION AND DISCHARGE:
1) Under these rules:
1.
Any delay in declaration ot probation does not give rise to automatic declaration since
there is provision for unlimited extension.
IG
U. Where the rules provide for fixed period ot probation and limited provision for
extension or no provision at all for extension then after the expiry of such penod if the
Govt, sen/ent ,s continued the period of probation is deemed to have been
automatically
, .
J
declared.
(Case Law. Kumar Chandra V/s State of Karnataka - ILR 1987 KAR 2756)
HI. Discharge of a probationer who
who was
was already
already in
in Government
Government service prior to
appointment as probationer results in his reversion to that earlier service or post (Vide
Note below rule 3).
IV. The probitioner discharged under rule 5 <or 6" has no right of appeal. That is in other
words the order once passed is final - Rule 8.
2) However, this provision in the rules do not tbar the
d., judicial serutiny. The affected
probationer is not prevented from approaching the CoJrt
r.
.
41
----- r™: °r the KAT but the scooe of
interference by the judiciary is limited to verifying whether the discharge is simoiicitor
or otherwise. Unless there is a prima-facie evidence in the order passed or records
' leadmg to the orders that the discharge is other then discharge simplicitor the courts
cannot interfere. However, if there is evidence to show on the records to the effect
. ^.t miscouncuc^ u, alleged and stigma attached, however innoouous the working in
the final
of discharge the Courts
hnal order ot
Couns can ask for the production of original records
and examining the matter.
(State ofMaharashtra V/s Saboji - AIR1980 SC 42)
X. CONFIRMATION
On declaration of satisfactory completion of probation a probationer is entitled to be
confirmed at t e ear lest opportunity in a substantive vaccancy that may exist or arise. Rule 9.
XL INCREMENTS AND PAY:
A probationer is entitled to draw all the increments that fall due during the prescribed
penod of probation. He is not entitled to draw the increments that fall due during the
extended period ot prooacion. - Rule 10.
After ^ihe expjry iof extended period on declaration of satisfactory completion of
prooat.on, a^> Lorn the date .ne declaration taken enect.the probationer’s pay has to be
tixed notionally taking all the increments due to him for the entire service but he is not
entitled to any arrears or pay. - Rule 1’0
j
XII. WHERE JUDICIAL PROCEEDINGS ARE PENDING:
pendin'’^
I
v Prot)ationer 13 questioned and judicial proceedings are
otherwise satisfactorilv cT’ I ' h PreSCr'bed penod of Pr°bation is over and if he has
he m-w h
sfaCtOr,ly c°mp eted the period of probation, the same may be declared and
he may be g.ven consequent benefits subject to final d.sposal of the said proceedings -
JOINING time:
I.
Transfer does not involve
change of statjon/residence(Ru 1e 77
Where the transfer of a
Government servant is within
tha station or doas not involve
change of residence hi a
joining time shall be
regulated as follows;
(a) where the Government
servant makes over change
in the fore -noon he should take
over charge in the after. noon.
(b) where the Cover
Movernnient
nment servant
charge in the after-noon he should take
in the fore-noon of the ®ucceeding day.
makes over
over
c ha rge
(c) where the isucceding day/3 is <
i
holiday or%re
hoLidaya he ahould take
--u over
charge in the fore-noon
of the next working day.
(d ) where an office/institution
fore-noon only a Government s er va nt
Join duty in the fore -noon should do
office/institution
function in the
who i s expected to
s
as soon as the
commences work.
(e) where an
a q o f f i ce/i ns t i tu t i o
functions onl yin
servant who is relieved at the
close of the o f f i ca/i ns t i tu t i □ n
is tr ea ted'as havi ng. been
relieved in tha after-noon.
n
the fore.noon a Government
(f) except under clause (c)
upto 12 noon is treated
as fore-noon.
II
Transfer tnv,ivw., rhanfTff
>es j d e nc e / s ta t i on : (Rul e
78)
Wriere a gransfer of a Government servant involves
c ha ng e af atation/rasidence he should be allowed
joi ni ng
t i me with reference to the distance between the
nee
old
Headquarters and
the
new
a
and the new Headquarters
direct route
as per s he d uI a given below;
I
Distance between
old headquarters
and new head
quarters .
Joining time
admiss ible.
. ?
Joining tin^e admis
sible where trans ft
necessary involves
continuour journey
by road for more
then 200 kms.
1000 km8 • □r less
10 da yn
12 days
Mor e
12
days
I 5 days
than 1000 kins
More than 2000 kms
15 days except in
cases of travel by
air to which maxi
mum is 12 days.
15 days
(b) The joining time commences on relinquishment of
charge
ix it is made over
if
on the following day if
in the fore-noon.
charge
It commences
is made over i n the after-noon.
III. Additional Joining time for taking over charge where it involves;
(a) verification of stores; or
(b) inspection of works#
Charge to be taken
Additi onal
joining time
Government Medical Stores.
15 days«
Department of
He^l th a nd
Family Welfare .
Super i nt end ent,
Medical Stores.
O'
I ecremext
k2'C<
R ci, v v o-
■
}
o. p. w. R
1. Increment accrues automatica
lly from the day following
that on which it ia
earned. (Rule 51(1))
2.
<
Increment is earned for completion of satisfactory
service
□f one calendar year .
3. From 1st April 1973 •n incrment which accrues
on the
day other than the 1st day of month shall be advanced
to
the first day of that month.
Subsequent increments
are regulated accordingly. (Rut
e 51(2))
4 • The following period s
shall hot count for earning the
increments, via;
(a) Period spent on suspension unless otherwise
d ecided on conclusion of inquiry. (Rute 55)
( b) period spent on
< *
extra-ordinary leave otherwise than
medical grounds. (Rule 53(b)(ii)7)
(c) period during winch the penalty of withholding of
increments 6r reduction to the lower stage or grade
is imposed under the KSCS(CCA) Rules, 1957.(Rule 59)
(dj periods subsequent to the period allowed for passing
the examinations, where the Government servant
does not pass the Kannada Language Examination
if not exempted) and the prescribed examinations;
11 anyt until he passes such examination/s • f Ru 1e L^1 A)
f
110
J
L.EAVK IWLE.S
k c'Xzvvt
I5'
‘r
■ xcxl
Cc \.zi a
d, p n C
106 •:
Leave includes Earned Leave, Hx 1 £ Pa y Loa ve , Ccnmutod
Leave, Leave not duo and Extra-ordinary Leave.
106 A:
(a)
Absence without leave - No £salary .. absence
to I-lilf Pay Leave to the extent
------ J
i't is due
treated as Extra-ordinary leave.
d o b i t ed
rest
(b)
Absence amounts
action.
diaciol 1 nax' y
106B:
:
10 7
112 :
Strike c.
L cave
to-mis-conduct
••
1 la bl o f or
Imo t entitle t □ any Leave.
canno t be claimed as
of right.
Earned Lc-ayg .- Credit in advance
ts t January and 1st: July.
f •' r c 3 h o. d a o i n t m e n t
- 15 day?
2-^ days per month in the
of appointment.
~
?. o t i r e m .o n t - 24 da'ys p er month in the
114 :
Not- exceeding
Leave not due - Limited
earn afterwardsa
Maximun? 36 0
Of f i cia1
117
;
to
days
of retirmept
ea c !i
n
time ,
likely to return to duty.
3 mo nt* hr
mo nt.hr;
7
employee
-is a-d rn 1 s ■ i b 1 p
or
when
No limit.
tn
i onths for serious ail-icrits.
} ars for u*nd cr-<jradu.rv te ./gradua t a/?? o s t
graduate courses.
Mq I e r n i__t '/ Leave
r .r 5)m
leave
wi t hout me di ca l c er t i .f i
for common ail me!: Is.
Cor
cle<Y3
year
year
ha 1 £ ~p ay I ea v e. like! y t o
Ex tra-> or d 2. na r y Lea ve • - LOien’ no
t he oil .1 c la 1 appliesJ for i t.
Otherj
!a1f
half the amount
days - 90 da ys at a
P or uia vic ri t / Qua s i permanent
I ? •’
hal f
Hal f-Pa y TLcave • Credit in advance - 10
1st January and 1st July.
Commut o<j Leave Ila 1 f -Pa y Leav c .
each on
l t s
f or
D o c t o r a t •?
fcma 1e
da t c
□f
r ■- >. v / a bq r b i p n. ■- 6
? n
C a vk'|vr^.£e—
e aks
servants:
e nt .
n
1
i
r i £ i C.-t t
.
^5
De
jrtmental Enquiries
K.R. SRINIVAS
Chief Administrative Officer
K.H.S.D.P.
A depanmental enquiry j
orc^ere^ against a Government Servant
under the provision of Karnataka
• Civil Services (C.C.A.) Rules, 1957.
Undy the provision of K-C S. (C.C.A.)
Rules is s^tXT^/^rX
a way unbecoming of a Government
Jervant has misconducted or acted in
Government duties, etc. the Aurhn > ant °^has shown dereliction in discharge of
Servant.
n
can mitiate enquiry against Government
In an enquiry there are two stages:
1. Investigation or Preliminary Enquiry
2. Depanment enquiry under K.C.S. (C.C.A.) Rules
s. "sp'ct “y si,e °r
orderedTnyestigatioo^asedItermnofw' ’
Authority or the Government as th P
K C S i C.A )
'h' ’“k" Wh° 1,35
Investigating Officer, th.e Disciplinary
may te
be ""
will deCide
decide whether enquiry under
^tigation.iftheas^n^Zttho^vorSA"^ ‘S
preCeded by an
prima facie a case exists anain« r
h AppointlnS Authonty is satisfied that
Government Servant under K. OS. (C CAJRuH Servant’ 11 can proceed against
Either on the basis of
nvestrgation Report^ or on the basis of available
evidence, charges will have
e named against Government Servant either under
Rule 11 or 12 of the Rules [f i
two or more ofticers are involved, a joint enquiry is
ordered under Rule 13 of the Rules,
If the charges are proved after enquiry, one of the
penalties as presenbed under Rule 8
will have io be imposed. If on enquiry if charges
are not proved, the Government Servant will
1
-xonerated of charges.
under Rule 10 is no:
whei die irregular::
e sc.i(,u> _.d .. [he Government reels that his
/3-Z
continuance in the post will hamnor
■
suspension, a subsistence allowance is pa.d tooTv^XTseXan^""5
A Government Servant who is placed under
suspension could be reinstated at
any t.me etther before completion of enquiry proceed
d'screnon of the D.sciplinary Authority [/charges ar! or after completion at the
suspensmn wdl be treated as on duty.' [f the cS^es ; not proved, the period of
are proved and a penalty is
Disciplinary Authority
be resu,arised- However at the discretion of
Government Servant^’
Y * adjUSIed aSainst anX leave at the credit of
preliminary enquiry (Invest:
evidence, the DiscipIin^Authori^wiilT°
n
°f avaiIab,e
Government
lcles
Government Servant
Servant (AGO/DGO) either under ^
Rule
! 1 of charges against th« Accused
- - I or 12 as the case may be.
If in the opinion <of" Disciplinary Authority, that irregularities Committee are
minor ones, he may initiate enquiry under Rule 12
th7f 7
RU1C 12 °f the Rdes- If eW is order
under Rule 12, only one o'f
of the following
mi
— penalties can be imposed against the
o owing minor
A43O.
1. fine (for Group ‘D’ services only)
2. censure
withholding of increments
3 a. withholding of promotion
4. reduction to a lower stage in the time scale of pay.
L«on«*heOSOin„,°i'.°'SS’XSfc n ofdcT“r'stf°are
irregularities committed
°fPay-
4 “ -™“
(vii) removal from service
(viii) dismissal from service
Even when an enquiry is ordered under Rule H rhe DA-■ r
a k •
.mp»s= any of .ha minor penaltlK also Bu, whe
Au.hon.y can
enquiry is taken up under
Rule
u e 12, no major penalty can be imposed on the A.G O'
The procedure involved in conducting an
followed scrupulously otherwise enquiry' will vitiate. enquiry' against A.G.O. is to be
evidence, the charges':
f °n the basis of avaiIabie
c.lar.and distinct. There should not hT
aga‘nst.the A.G 0 The charges should be
hXe to be explained in -h/f “
r 1"? amblsu‘V ,n [he charges. The charges ill
document bv w^ ty
°f 'r—r
^conduct’ The
' amt!s Ot d5arges are t0 be sustam^d and the list of witnesses
to be examined by the D.sciplinarv Authority in
support of charges will have to be
listed along with Articles of charges.
of misconduct, list of
documems^is'ennd theXXoTJ^
The A.G.O. should be aiven a reasonable t
W11'have t0 be served on the A G 0
statement of his defence^ to state WhethJ he^X^^X^ "h™ '
himself or appoint an wqui^officer^o ^Cip,inaiy Authorit’/ W induct enquiry
which are not admitted bv the AGO K S
' 7°
art'CleS °f Charges
A.G.O. then there ic nn n
‘ a anicles °f charges are admitted by the
authority competent to imno
Pr°^eed ftjrther The Disciplinary Authority or the
“R- »y of <»e
P-J.”ePX,:P” penate Und,ir ,h' R“fe
” h“
DiscipJ^l^^
‘ta ■'»
Disrinlinarv Authoritv r™
char£es or aPPOint an inquiry officer. The
presenting officer on beiif oflT^TA-oX'" “ “
h''"'
officer aTfte'r'SX0.?';
Sii appear
nersln™ T"'
assurance of another
a legal practitioner.
‘
"°"“S ” th' A 00 10
rr°m ‘h'
Present befors “W
A“'h“ily- Th' A ° °
AG° ”” *°
ant or a retlr^ Government Servant who is not
the chafes or^he AGOp'G 0' Whether the A G 0 is -u,kv of anY of
™5 “ “ “
Officer
°fficer without valid reason
his absenceorXes^to
produce"
take extracts of stateme
all°^ed l° insPect anV of the documents and permit him to
- -—■»
=Th=A G
on his behalf.
cross exami^y “a°G 0 "S
Tx'T
ZXX fOr DiS‘ip!inaiy AUthorit*'is
H
by P0
The A.G.0 shall X h^
dgnce orally or m mmatmg. A copy of the defence statement should be given to the
,
The A G O. r
' examine himself and also examine the witnesses to be cross
rnuy
evanined by P.O and
2 re-eximined by AGO if necessary The Inquiry Officer can
also put questions.
-J
■
The Inquiry Authority after completion of production of evidence permit the
to a dress his argument and record the same. The Inquiry Authority may also
permit the P.O. to file his written arguments.
er completing enquiry, the Inquiry Authority will draft inquiry report to be
su mitte to t e Disciplinary Authority’. In the inquiry report, the Inquiry' Officer will
ave to ana yse each charge on the basis of evidence placed before him and record his
n mgs on eac article of charges. These findings will be submitted to the Disciplinary
Authority in form of inquiry repon along with documents.
The Disciplinary Authority after receipt of inquiry findings will examine the
report ot the Inquiry Officer and proceed further. If the findings reveal that the gravity
e c ar es u_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
- arges is so severe that, it warrants a major penalty as specified under Rule 8, the
iscip many utnonty may impose major penalty if he is competent to do so or
orward the inquiry report to the Authority competent to impose a major penalty:
If Disc.plinary 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.
^mP0s^ng a major penalty, a second Show Cause Notice to be served on
’
’’ en^*osing copy of the inquiry report. There is no need to intimate the
penalty proposed.
rk
a
Against order of the Disciplinary
y Authority, the A.G.O. can tile an appeal to
the Appellate Authority. Appellate Authonties
> .are prescribed for various classes of
services as given in the classification.
enquiry is ordered under Rule 12,
charges,
. ° statement
. of
0 imputation,
imPJtatI'on, defence
defence statement, evidences placed, record findings
and impose a minor
penaltv
given in
uIp r8.
.
*
- ‘ penalty as
as given
in P
Rule
<
■
n- • r hen two or more Government Servants are involved in a proceedings the
rhA? ‘H 17 AL‘l\h°rity may order J°int enquirV under Rule [3. Even in a joint inquiry
e Rule 11 or K may be followed depending on the severity of the charges.
p i i iJ/i\e (^0:e,^ent Can aPPoint Lokayukta Officers as Inquiry Authority under
• | . 3 ? L *e " U es’ T^e Inquiry Authority can in sbch cases modify or alter the
articles ot charges out they cannot frame the charges on them own.
Special Procedure in certain cases
The Compe.^.t Disciplinary Authority under Rule 14 rnav without, holding anv
Rul'
..pc^.tiea in Rule 3 on Government Servants
impKemv 3f:h= faife
'
charge gr°Und
conduct which has lead to his conviction in a criminal
2. a) where he has absconded.
b) where he does not take part in the inquiry
is not
*S sa^s^e<^ ^at in the interest of security of state, it
• pedite at follow the procedure in C.C A. Rules.
The i;important Acts and Rules to be familiar with:
1. K.C.S. (C.C.A.) Rules, 1957
2. K.C.S. (Conduct) Rules, 1966
3. K.C.S. Rules
4. The Karnataka Finance Code
5. The Indian Penal Code
i
t -
• to make recyclable items , such as needles, become
unusable.
Various treatment methods:
Incineration: a piocess
|
of burning infectious-hazardous
waste under controlled combustion , the end product will
be sterile residue and emissions.
Regional Incineration: One well-run, state-of-the-art, air
pollution-equipped incineration is better than many small
incinerators.
9J
) r < /
Microwaving: the process incorporates shredding, steam
spraying and micro wave 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.
94
t-
o -
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 , universa
piecautions, personal pretective equipment, etc.
‘>5
!
Contracting out Services i 1’..
in Hospitals under
Karnataka Health Systems Devel
lopment Project
K.R. SRIMVaS
Chief Administrative Officer
K.H.S.D.P.
people, the hospital should'hme’ thTre°”al d
F,'°V'de Satisfac“>,>' s'r-iCe 10 >1*
setviee attd „a.nte„a„ce servic The' T ,a e ’’’V0"" b°Ih
“™5 °f
of these services e.ther ' Z! re
f°r"”>«Semen,
requirements, a system^ b
,
I" OT
1”Kal s=™ce. In addition to these
h'*'’ Z' Sh0UW b' a W""° “^arge the
duties satisfaetordyTn most t theC “
many hospitais we find that the oostsam Z m! a “’“to' *' S“”ari° is different. In
and the funds are not adequate to meenhe0* '
UP
SpeCiaIists are not available
interest among the staff Jo providTthe
In addltion
Ats, there is no
criticism by the public and the elected renr^Tf " h
°f lh’S’ there is alWays
good. When we say service\ond
services like cleanliness in the hos >7
Chnical service> non-clinical
requirements. Any deficiency in any of thesmfinidenanCeiH°f equipment or administrative
friendly environment and delays in replies etc^
1 m lmprOper Service’ non-
to addressClesr„mroanhae”' moWems”'itf,^’’’T' Z'"’ “ “""P*
1
1
conditions, mrprove adm“isM^ effi™
Government Hospitals.
Z"™' °f Pr0Vi<li""
been made
s'™“
Cy and 3 S° 10 Provide good environment in
Contracting out Non-clinical Services in Hospitals
reasons for this I^ke^n-T^Jhbfii^ofS’ C^an'lneSS is a Prob|em. There are several
cleanliness, indifferent anitude of the wo t
There are instances where
tm!Xe
ffiC
nUmber of PeoP]e m maintain
CMn£SS m the h°Spkals
, open, they need continuous maintenance
S™pIe reaS°n thaI *f they
kePt
environment should be good and hymenic The°r
t0
friendly’ its ’
service. Considering the importance of m t
of providing clinical
Community Health Centre at Devanahalli within
h?SP'tal environment> °oe
non-clinical service by involving a nrivate
Up f°r maimenance of
non-clinical service was discussed amonoct thgency On pdot basis- TTien the concept of
the issues related to non-clinica amongst the project officers, the consensus was that all
maintenance budget will not be ne^e^1^ ,Sh°Uld . be addressed so that a separate
finalised wfth the n”va,' ”
? 'be l’ospmb
»»d conditions
non-clinical services like mainilZ. h
,H°S°“ai: 111 the issues related to
maintenance of water .ZZ**- in
mopping of floor,
replacement offused bulbs and tubes ’ ”ainte"a"" “f elecmerty ensuring timely
tubes, maintenance of hospital exteriors, management of
tospital waste on scientific basis in terms of the regulations of Government of India were
considered and incorporated in the terms and conditions. Since it was a pilot prcect. there
'vas a frequent monitoring of the mechanism by the project officers.'This'Devanahalli
S
7S entrUSted :°r maintenance of non-clinical service at a monthly rate ofRs.
’
°r a Perioh Ci one year. The cost of maintenance of non-clinical services at
Devanahalli Hospital was equivalent to the salary of 6 Group ’D' employees excludins
*e expenditure on Detergents, Disinfectants, etc. There was also no expenditure on items
hke electnc bulbs, tubes, taps. etc. The maintenance contract included not only the wagfes
out also the material component. Therefore it was thought that there will net be anv
expenditure for maintenance of the hospital for a period of one year. The agency was paid
the charges every month on certification by the concerned medical officer" Ove- a period
ot one year, the experiment was found to be very successfril in terms of maintenance of a
ovemment Hospital, without any additional expenditure on routine maintenance or.
annual maintenance.
The.pilot projec. was visited by the World Bank members and considering the
X maintenance’ the WorId Bank Review Mission in their Aide-Memoire of Mav
1998 gave the Benchmark of extending this facility io another 10 hospitals by November
end. As Devanahalli hospital was taken up on a pilot basis, detailed procedures were not
gone into before entrusting it to an agency. As this work is taken up under operational
expenses, there is no standard Bidding Document of the World Bank. In order to ensure
transparency m the Bidding process, the standard Bidding Document for civil works was
adopted and with suitable changes, a Bidding Documentor contracting out non-clinical
services under Local Shopping Procedure was prepared. This Bidding Document is being
used for inviting bids for contracting out maintenance of hospitals. A detailed schedule is
prepared in the Bidding Document in which there is reference to even the minor activities
an agency has to do in the hospital on getting the contract for maintenance of non-clinical
service. A copy of the Schedule from the Bidding Document is enclosed to this as Annei;
After Devanahalli Hospital, in three more hospitals non-clinical sen-ices has
a ready been contracted out to private agencies. The hospitals covered by this facility are
(a) Taluk Level Hospital. Magadi, (b) Taluk Level Hospital, Kunigal and (c) Taluk Level
' Hospital, Nelamangala. The rates offered by the successful bidders in respect of these
three hospitals are Rs. 23.000/-, Rs. 30,200/- and Rs. 26,200/- per month respectively!
lhe maintenance cost in respect of these three hospitals which is given to a private
agency is less than the expenditure that the hospital would incur on the salarv of Groufi
D employees and the detergents they purchase in the hospitals. In respect of eiuht more
hospitals, the bids have been taken and they are in the process of evaluation. While
providing this facility of maintenance of non-clinical service in hospitals through a
private agency is considered by the protect, the consent of the respective hospital
superintendents and the local administration is also taken. This facility is not beinn civen
to the hospital unless the hospital authorities come forward to have this facility in their
hospitals. The funds are provided by the project at present as the salary component for
Group ‘D’ employees is not being utilised as the vacancy of Group ‘D‘ employees are not
9
i
1
tilled up. It is considered that this facility could be continued even bewnp the project
would X
°L: T Salary comP°nent which the State Government otherwise
incur will be u. verted tor payment of service charges to private aeencies.
Hiring the services of Anaesthesiologists in Government Hospitals
hosnimk dadd,tt°h l° m.ainlenance
S for So ZT SH
hospitals, it is also the experience that many of the
” ,0 Pr0Vid' S'™“ ,0 'h'
- —1
-the rdltiOn aS SIated ab0Ve-
^e Go™? OrZ
reasons for this proclem. However, the public at large is deprived of th- reouired
specia ist service in the hospitals. Considering this problem, as a short time measure the
oZeXm^ZsoS' ~TfaC1Ii;y °f hirmg the services of P™* Anaesthesiologists in
government Hospital, where the post of Anaesthesiologists is sanctioned but no^t filled
p. . project has ts.ued a Government Order wherein this facility is extend-d to ail the
Hiring the services of Lady Medical Officers
Wome„'" ’S' chX P
y' Z‘Cc °dfL< Medical ?ffiCOT for
osOffip
•, L he SC/ST population. Wherever the services of Ladv Medical
“y ZeaToff'
Officer can h“e heW™“'
dy Med,cal Office, rrom pnvate sector by giving an honorarium of Rs. 500/- per camp
Hiring the services of Specialists i
in Government Hospitals
Considering the success of
providin0 specialist
servimo
-rfrom
of providing
specialist
service
possibilities of takine the services
nf
r
T
frOm privats sector’ the
proper referra! network in the Government Hosp™,'
P
“P
“
Contracting out Equipment Maintenance in Hospitals
i
The maintenance cf cequipment in the hospitals is also an important component.
The experience in the Government Hospitals is that
I many of the equipment go out of
1
q
'5 O
order and due to this,
’ diagnostic facilities
are adversely affected. In Government
Hospitals. X-ray Machines are very important and they are used on
a regular basis in (he
ospitals. There were instances wherein the X-rav Machines werp
u
repaired for years together. The equipment maintenance team at the FT '
finding it very difficult >0 take care of the equtohe” “a ZaXe
th F
Hosnitnls af-rntfc rr. C
a
Hulp.ient maintenance in the government
Hospitals across the State. There used to be repeated requests from --e Hospital
Superintendents and elected representatives to repair X-rav Machines in the hospitals
Considering the problem and inhouse deficiencies for maintenance of X-rav \fa b-P
all the hospitals, the servicing and maintenance of X-rays was contracted oit'for a period
f one year to a private agency namely M/s. Mediwave, Banaalore As pe- the agreed
th^b “ f°ndltI0!?S- the technicians of this agency would visit an
an hospital ’’o anend to
000/£ ne 7n 01
ay MaChine 00 hearing frOm rhe project- The acencv is P*>d Rs
l"n cX’ 0^0™^“ ^r868
“n
ail°WanCe t0 the technicians al^.
In case of minor prohems, the technicians would attend to the problems and set ri^ht the
X-ray Machines ana take the service charges from the project. If there are any "major
problems which require replacement of spare parts, the aaenev would come back to the
project and give the details of problems and the spare pans to be replaced. On supply bf
the spare parts, the agency would again attend to the problem and set right the X-ray
Machine. In a period of one year, the agency was given servicins and repair^' 107 X-ray
Machines. Of these 107 X-ray Machines, the agency was able to repair and service 90 Xray Machines valued approximately at Rs. 4 Crores. The expenditure incurred on the
service charges paid to the agency for these 90 machines is Rs. 2,73,000/-. In addition to
expeSi^X - 1 ih000/’
H the Procurement
^are pans. Th s
expenditure of Rs. j., lakhs is approximately salary of one officer and two technician in a
Government Sector. It would not have been possible for the technical peoole in the
Department to repair and service so many X-ray Machines. As this has been proved to be
quite successful and encouraging the service contract of the agency is renewed for one
more year as approved by the Steering Committee.
Providing support sendee to Administration
offices. In addition to this the security is also contracted out. The service .uDoort for
administration is taken from Man Power Agencies. The housekeeping in the'project
offices is also contracted out to private agencies.
The project has provided the service support in administration to the proiec
hospitals also^ Many of the Administrative Medical Officers were requesting the pro ect
to provide the services of Typists for day-to-day. administration in the hospitals
HealA
n n°n'availability °f Sufficient nuX
rypisxs in the Directorate oJ
nnv re t
7' 3 PrOV'S’On 15 mad£ f°r getting th£ J°b Of ,yPing
private agencies. For the job done by the private agency, the Administrative Medical
Oiiicers will pay an amount as detailed in the Government Order issued in this resard. A
vopy or the Government Order is enclosed to this as Annex III
IO
Annex I
Schedule of Work
SI.
No.
I
Item of Work
Maintenance of Walls
~~
Contractor will ensure that no poster or publicity material is
pasted on walls He will ensure that no walls are disfigured by
non-hospital related wall writings. In ca.P tbp
,,
7
disfigured it would be restored to its orig^X^
same quality of paint or distemper The nortinn f ■
walls in injection room, c'asoahy room „aX" °"
'"“n°r
table, kitchen, reception desk etc S “ f ™S
dtstignrement by t„uchm4 are to ’be cieanTd Xmted'X'
pcX'ofd'”11"^
“,U
’■■“S
especially of drags and pharmaceuticals are posted in the '
examination room, pharmacy, reception or anywhere in the
walls is avoided. The comers and crevices are to be detmed
with a vacuum cleaner at least once a week Thprs. k u
be any cob web in the hospital.
’
Sh°U d not
Oiling of hinges
iXzz" a'zz jk: “ r zr
Excess oil and subsequent accumulation of dust o/spiZdi
sT I be'kXt h‘y WiP'd “d- A1' d00rS’ Wi”dows’
dXeXmsXrZZ
Cleaning of floor
should be swept at 6 AM, 1'PM “d 5 PM "and™ “h’
Detergents with neutral pH (7to8) and H' ' r
phenol coefficient of (RWQ) 3 to S to be used vXXnT
Cleaning of ceramic tiles and glasses
J
All the glazed tile portions of the hospital like OPD In patient
blocks, examination rooms etc., are to be cle.n h
toxic, food .grade detergents end ilSinfZts X aX
deaned" w,m
aiUmi"Um Pan'“»" ^uld be
c eaned with eco-friendly detergents and disinfectants The
glasses which become loose are to be pronerlv rPr
i
patt! or thick beading wherever required The brtW^ 7 '
must be replaced immediately.
The broken glass
TfAH 7—0,
1
SI.
No.
Item of Work
Maintenance of toilets and wash basins
All toilets and wash basins are to be cleaned with non toxic,
food grade detergents and disinfectants once a day. The flush
must always be functional and there should not be any leakage.
All broken tiles of wash basins, flush tanks must be replaced
with spares of the same make. All broken tiles in the toilets
are immediately replaced. Toilet requirements like water mug
and washing liquid soap are to be provided in all toilets and
examination rooms.
The dettol lotion being kept in the examination room is to be
cleaned every day.
The drain chambers are ito be thoroughly cleaned once a week
as part of preventive maintenance. Immediate attention should
be paid when the drain pipes or chambers are clogged. The
soak pit will have to be cleaned once in six months and the
excavated material must be disposed safely. Sink and chamber
covers shall be securely fixed to be air tight.
The cost of cleaning materials, .tools, detergents, disinfectants,
bleaching agents to be borne by the contractor. Only non toxic
grade acids are to be used.
Maintenance of drainage system
The roof tops are to be cleaned to remove dust, leaves and
other kind of debris. No plant growth of any kind is to be
allowed on roof tops. Dust and mud that usually accumulate at
the mouth of drainage pipes on roof tops and chajjas are to
scrupulously removed. The terraced roof top has to be cleaned
at least once a week. No drain pipe should be clogged. There
should not be any leakage of water from any drain pipe.
Repairing damaged pipe and restoring drainage system is the
responsibility of the contractor. The outlet piping provided in
chajjas shall be cleaned so that water accumulated is easily
discharged.
No wash basin, gully trap, water closet, commode or any other
water outlet should be allowed to be clogged. If clogged it
should be restored at the contractors cost.
Maintenance of bed linen etc.
The contractor will be the custodian of bed linen, woolen
blankets, mosquito nets, pillow covers and cushions handed
over to him by the administrative medical officer. He has to
J1
SI.
No.
Item of Work
replace used bed linen in ’’
------------wards, examination rooms and
Casuality once a day with washed i
’ pressed and sterilized
linens. Autoclave for sterilizing will be
provided by the
administrative medical officer. However the
cost of detergent
and all other requirements for washing 'and
pressing is to be
borne by the contractor.
Cleaning of the linens fro:'m 0 T. and Labour room will have to
be attended if directed so 'by the administrative medical officer.
Stretchers, wheel chairs should be maintained and should be
funcuonab Maintenance of wooden furniture. Maintenance of
Macintosh is also the responsibility of the Contractor.
Maintenance of Hospital Exterior
i
I
1
Weeds grownng in the hospital premises must be de-weeded
once m 5 days. The de-weeded material must be transported
outside the hospital and should not be bum, in the hosphal
premises. The decorative phms nem the portico and’the
entrance must be mamtained suitably. No patient artendent me
to be allowed to cook food in places other than desi.na”
Whin the hospital premises. .Activities like selling
food
stuff tender coconut within the hospital premises by
*°n“d Pmon!
be prevented. The hospital gates
should be maintained and weU secured at all times. The g5de„
wh,eh IS already developed in the hospita! premises must be
maintained by providing .adequate water, soil working and
nutnents.
g
G
Cenam portions of the windows and ohazaas in certain wards
often get disfigured by the patients throwing out the
from such windows. In such eases adequate precautions are o
be taken and whenever such disfigurements take piace the
window panes and the ehazzas are to be painted suitabiy with
the same quality ofpaint and distemper used earlier.
Maintenance of Hospital Lighting
I
J
The contractor would ensure that all incandescent bulbs and
Wbe lights provided the hospital would function.
the oulos ano tuoe lights and starters are bum. ,he co„lr,ctor
would replace them with new buibs and tubes of the same
wattage, and quality.
same
The contractor would ensure that all the plugs and switches in
the hospital remain intact, Whenever they are spoilt they
should be replaced.
e generator and inverters are
1 \
SI.
No.
Item of Work
maintained by the contractor’ s but the fuel charges and the cost
of lead battery are met by the hospital.
Yard lighting maintenance is to be done by the contractor.
However it is limited to replacement of burnt bulbs. The
contractors is not responsible for functioning of medical
equipments like O.T. light, infrared lamp, examination light
etc. Electric pole and fittings of yard light shall be painted and
kept free from rusting.
Electrical Maintenance ~
The contractor would ensure the functioning of plugs,
switches, socket etc., in the hospital. He would be responsible
for cleaning of the fan 'blades once in fifteen days and he
would also undertake the repair of ceiling fans as and when
needed, ihe contractor should provide upto a limit of 4 new
plug points at the direction of the Administrative Medical
Officer during an year. However, whenever the length of
extension of electrical line is more than 10 meters the
additional cost is borne by the hospital. The contractor would
take up. the cleaning of Instrument sterilizers in the casuality,
wards, injection room etc. However, he is not responsible for
maintenance and repair of other medical equipments.
Water Supply
The contractor would ensure the functioning of the whole
water supply system. Leaks if any in the pipe line should be
rectified immediately. He should ensure that all the taps
available in the hospital would function properly. The'non
serviceable tap should be replaced with new ones of the same
make and kind. He should ensure that the water meter is
functioning properly. The overhead tanks must be cleaned
once in a month. The contractor should attend to problems
relating to the water pump within 8 hours after the defect is
identified.
The solar water heating jsystem of the hospital must be
maintained, by removing the dustt on the glass panel.
Waste Disposal
The waste must be collected in the designated bins throughout
the hospitals and it should be disposed as indicated in the
instructions on waste disposal attached to tJhis schedule. Bins
and accessories will be provided by the hospital.
Interior Decoration
Decoration plants must be provided in the corridor and at the
!
I
10
si.
------
No.
Item of Work
reception. Flower vase must be provided at the reception ----t e nospital. All clocks must be kept in working condition and
t e oatteries are to be replaced by the contractor.
Th^e cow catch placed at the entrance of the hospital must be
clean so that it remains functional. Materials like old
constructmn debris, used cloths, polythene containers, carrv
ags, dead wood, packaging material, useless stones etc., must
e removed out of the hospital premises so that the
surroundings are kept clean always. All items with drains shall
be cleaned so that there will be no water stagnation around the
hospital during the rainy season.
Painting of cots, bed side lockers, saline stands etc.
The cots, bed side lockers, saline stands, food trolleys and
trays must be painted once in six months and rubber bushes .
faired it should be provided. ' Stretchers, wheel chairs
should be maintained
— iin a functional state. Wooden furniture
should also be jmaintained
‘
in.a functional order. Rubber
materials like makintosh
should
-------- ------- 1 be maintained free from
fungus.
Maintenance of Interior Roads within the hospital
The small strips of black top roads within the hospitals might
^surier from pot hole. The contractor must fill up the pot holes
— using-the j ally, sand and bitumen. - --------Maintenance of hospital pharmacy
The hospital pharmacy must be specifically kept clean and
decorated. All waste must be removed on the direction of the
pharmacist.
Display of IEC
The board in front of the hospital must be painted atleast once
in a year as per the directions of the Administrative Medical
Officer. The location of various facilities and the utility of the
vanous rules and instructions to users must be displayed as
directed. The display labels will be given by the hospital
authonties and the contractor will ensure that it continues to be
isplayed at the place where it was and the signs are not
C’s.igured. No stickers publicizing certain drugs will be
allowed to be pasted anywhere in the hospital. ~ The IEC
matenals must be displayed at the designated places only.
utdated posters and irrelevant notices must be removed at the
direction of the Administrative Medical Officer.
Maintenance of fire protection Units
The contractor will keep sufficient number of sand
filled red
ir
SI.
No.
Item of Work
c0J0ur GI buckets and spades. The buckets and spades will
have to Ibe procured- -by the
- contractor himself. The Contractor
will display the IECJ material on Fire protection units at
appropriate places as indicated by the Administrative Medical
Officer. These display materials will be supplied by rhe
A ministrative Medical Officer. Tire contractor will keep the
Fire Extinguishers at the appropriate places as indicated by the
Administrative Medical Officers. The Fire Extinguishers’ will
e supplied by the Administrative Medical Officer but will be
maintained by the contractor.
Doctor, Consumer Protection and
Adjudication of Liability
Dr. S.V. Joga Rao*
THE CONTEXT
patient’s riqhts Thic5^'6^15 ®xp^ri®ITcin9 growing awareness about
in lihr. tS. rend is clearly discernible from the recent sourt
ity. B^and IarOqeC^'n9rtme<?'Ca| professional or establishment liabilfor fho ff •9 ^eSe ltigate claims are preferred claiming redressal
o( SdeT?/’"-tO "!e‘ii“l n'9"3““’
The eoniroversM SuXTS^'
.pZX »ex98dx^t'° ™d'“
be aD^recSpr-initiatiVe °f ri9hts Protection squired to
be appredated m the economic context of rapid decline of Sta e
sxiFSSxrxiapptaion ol J0rc,XXX “XXX :! ,3
and cultural relevance would undoubtedly lead to a.bltraXcls o“
Mtor’
‘
3
; v? O
However, it is equally essential to note that the protection of
patient s right shall not be at the cost of professional integrity and
autonomy. There is definitely a need for striking such delicate
balance. Otherwise the consequences would be inexplicable.
In the context of obtaining processes, there is a deserving need
for two-pronged approach. On one hand, the desirable direction
points towards identification of minimum reasonable standards in the
light of social, economical and cultural context which would facilitate
the adjudicators to decide issues of professional liability on an
objective basis. On the other hand, such identification enables the
medical professionals to internalize such standards in their day-to-day
discharge of professional duties, which would hopefully prevent to a
large extent the scenario of protection of patient’s rights in a
lltlgative atmosphere. In the longer run, the present adversarial
placement of doctor and the patient would undergo transformation
to the advantage of both patient and the medical doctor and society
at large.
THE CONSUMER PROTECTION ACT, 1986
The Consumer Protection Act was passed in 1986 with a view
to provide for better protection of the interests of the consumers.
The Act makes provisions for the establishment of Consumer
Protection Councils and other authorities such as Consumer Dis
putes Redressal Forums at the National, State and District levels for
speedy and simple settlement of consumer disputes.
SALIENT FEATURES OF THE ACT
a.
The Act recognises the right of the user other than the buyer
- also to sue the manufacturer by defining the word consumer to
include user also.
b.
It empowers an individual consumer or a recognised consumer
association whether the consumer is a member of such
association or not to file a complaint in respect of defective
goods or deficient services.
It covers not only goods as defined under the Sale of Goods
Act, 1930 but also services including services provided by public
sector undertakings and government departments such as
banking, financing, insurance, transport, processing, supply of
electrical or other energy etc.
4
d.
It defines the rights of consumers. They include:
1.
the right to be protected against the marketing of hazard
ous goods;
2.
3.
the right to be protected against unfair trade practices;
the right to be assured access to a variety of goods at
competitive prices;
the right to be heard and to be assured that their interests
will receive due consideration at appropriate forums;
the right to seek redressal against unfair trade practices or
exploitation and
4.
5.
6.
the right to consumer education.
e.
It provides for the establishment of advisory bodies at the
Central and State levels to be known as Central Consumer
Protection Council and the State Consumer Protection Coun
cils with the object of promoting and protecting the rights of
consumers.
f.
It provides for the establishment of quasi-judicial bodies for the
redressal of the grievances of consumers at the District, State
and Central levels known as District Forum, State Commission
and National Consumer Disputes Redressal Commission.
-_g
It Jays down the procedure to be followed in redressing
consumer grievances and-provides a time limit for the disposal
of their complaints.
h.
It empowers the District Forum to issue orders to the opposite
party to remove the defect from the goods or to replace the
goods or to return the price or charges paid and or to pay
compensation for any loss or injury suffered by the consumer
due to the negligence of the opposite party, in respect of
defective goods or deficient services.
i.
It empowers the District Forum, the State or the National
Commission to enforce its order in the same manner as if it
were a decree or order made by the Court, and in the event of
Its inability to execute it, to send such order to a court of
competent jurisdiction for its execution.
5
^4
\^o
j-
It empowers the forum or commission to impose a sentence of
imprisonment of not less than one month extending to 3 years
or with a minimum fine of Rs. 2,000/- extending upto
Rs. 10,000/- or with both, for failure to comply with any order
made by it.
k.
The 1993 amendment has empowered the forum or commls.sion to order payment of compensation by the complainant to
the opposite party if the petition appears to be frivolous or
vexatious in nature. The amount shall not be more than
Rs. 10,000/-.
WHAT A MEDICAL DOCTOR SHOULD KNOW ABOUT
COPRA?
1.
Who can file a complaint?
A consumer or any recognised consumer association, i.e.,
voluntary consumer association registered under the Compa
nies Act, 1956 or any other law for the time being In force,
whether the consumer is a member of such association or not,
or the central or state government.
2.
Who is a consumer?
A consumer is a person who hires or avails of any services for
a consideration which has been paid or promised or partly paid
and partly promised or under any system of deferred payment
and includes any beneficiary of such services other than the
person hires or avails of the services for consideration paid or
promised, or under any system of deferred payment, when such
services are availed of with the approval of the first mentioned
person. This definition is wide enough to include a patient who
merely promises to pay.
3.
What is a complaint? ■
A complaint is an allegation In writing made by a complainant,
i.e., consumer that he or she has suffered loss or damage as a
result of any deficiency of service.
_4.
What is deficiency of service?
Means any fault, imperfection, shortcoming or inadequacy in
the quality, nature and manner of performance which is
6
required to be maintained by or under any law for the time
being in force or has been undertaken to be performed by a
person in pursuance of a contract or otherwise in relation to
any service.
5.
Where to file a complaint?
In the district forum if the value of services and compensation
claimed is less than one lakh of rupees; before the state
commission, if the value of the goods or services and the
compensation claimed does not exceed more than frve lakhs. In
the state commission, if the value of the goods or services and
the compensation does not exceed more than twenty lakhs of
rupees. In the national commission, if the value of the goods
or services and the compensation exceeds more than twenty
lakhs of rupees.
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 commission, from the state commission before
A^P^lIoQal 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?
(a)
the summoning and enforcing the attendance of any
defendant or witness and examining the witness on oath;
(b)
the discovery and production of any document or other
material object producible as evidence;
(c)
the reception of evidence on affidavits;
(d)
the summoning of any expert evidence or testimony;
(e)
the requisitioning of the report of the concerned analysis
or test from the appropriate laboratory or from any other
relevant source;
7
/a
(o
issuing of any commission for the examination of any
witness; and
(g)
any other matter which may be prescribed.
WHAT IS THE SUPREME COURT’S DECISION?
(1). Service rendered to a patient by a medical practitioner (except
where the doctor renders service free of charge to every patient
or under a contract of personal service), by way of consultation,
diagnosis and treatment, both medicinal and surgical, would fall
within the ambit of ‘service’ as defined in Section 2(l)(0) of the
Act.
(2)
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 Medical Councils consti
tuted under the provisions of the Indian Medical Council Act
would not exclude the services rendered by them from the ambit
of the Act.
(3)
A ‘contract of personal service’ has to be distinguished from a
’contract for personal services’. In the absence of a relationship
of master and servant between the patient and medical practi
tioner, the service rendered by a medical practitioner to the
patient cannot be regarded as service rendered under a
'contract of personal service’. Such service is service rendered
under a ‘contract for personal services' and is not covered by
exclusionary clause of the definition of ‘service’ contained in
Section 2(l)(0) of the Act.
(4)
The expression ‘contract of personal service’ in Section 2(l)(0)
of the Act cannot be confined to contracts for employment of
domestic servants only and the said expression would include
the employment of a medical officer for the purpose of
rendering medical service to the employer. The service rendered
by a medical officer to the employer under the contract of
employment would be outside the purview of ‘service’ as
defined in Section 2(l)(0) of the Act.
(5)
Service rendered free of charge by a medical practitioner
attached to a hospital/nursing home or a medical officer
employed in a hospital/nursing home where such services are
8
U:
rendered free of charge to everybody, would net be "service” as
defined in Section 2(l)(0) of the Act. The payment of a token
amount for registration purpose only at the hospital/nursing
home would not alter the position.
(6)
Service rendered at a non-Govemment hospitaJ/nursing home
where no charge whatsoever Is made from any person availing
the service and all patients (rich and poor) are given free service,
is outside the purview of the expression ‘service’ as defined in
Section 2(l)(0) of the Act. The payment of a token amount for
registration purpose only at the hospital/nursing home would
not alter the position.
(7)
Service rendered at a non-govemment hospital/nursing home
where charges are required to be paid by the persons availing
such services falls within the purview of the expression ’service’
as defined in Section 2(l)(0) of the Act.
(8)
Service rendered at a non-Govemment hospital/nursing home
where charges are required to be paid by persons who are In
a position to pay and persons who cannot afford to pay are
rendered service free of charge would fall within the ambit of
the expression ’service’ as defined in Section 2(l)(0) of the Act
irrespective of the fact that the service is rendered free of charge
to persons who are not in a position to pay for such services.
Hee service, would also be .."service".and-the recipient a consumer under the Act.
—— -
(9)
Service rendered at a Government hospital/health centre/
dispensary where no charge whatsoever is made from any
person availing the services and all patients (rich and poor) are
given free service is outside the purview of the expression
serv.ee as defined in Section 2(l)(0) of the Act. The payment
of a token amount for registration purpose only at.the hospital/
nursing home would not alter the position.
(10) Service rendered at a Government hospital/health centre/
dispensary where services are rendered on payment of charges
and also rendered free of charge to other persons availing such
services would fall within the ambit of the expression ‘service’
as defined in Section 2(l)(0) of the Act irrespective of the fact
that the service is rendered free of charge to persons who do
9
not pay for such service. Free service vcould also be "service"
and the recipient a "consumer" under the Act.
(11) Service rendered by a medical practitioner or hospital/nursing
home cannot be regarded as service rendered free of charge
if the person availing the service has taken an insurance policy
for medical care where under the charges for consultation
diagnosis and medical treatment are bome by the insurance
company and such service would fall within the ambit of
‘service’ as-defined in Section 2(l)(0) of the Act.
(12) Similarly, where, as a part of the conditions of service the
emp oyer bears the expenses of medical treatment of an
employee and his family members by a medical practitioner or
a hospital/nursing home would not be free of charge and would
constitute ‘service’ under Section 2(l)(0) of the Act.
HOW ADJUDICATION OF LIABILITY TAKES PLACE?
•
Process before fhe competent forum will be set in motion
in the following manner. When the complainant files a written
complaint, the forum after taking cognizance of the same, sends a
Witten notice to the opposite party asking for written version to be
submitted within thirty days. Thereafter, subsequent to proper
scrutiny, the forum would ask for either filing of affidavit or
production of evidence.
underhand!
SitUati°n °f medical negligence liability for proper
DEFINITIONAL ASPECTS
Negligence Is simply the failure to exercise due care. The three
ingredients of negligencei 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 in medical
negligence case, most often, the doctor is the defendant.
10
WHEN DOES A DUTY ARISE?
Consider the following fact situation.
dn t A ‘Sfini“red in an accident. He is immediately brought to a
refuses '7 7^ment- The doctor B obse^es that A is dmnk. He
*
I
doctor, who"?
h3116 a
th3t aCC0Unt' A is taken t0 another
from L i
L LL h°WeVer’ d°es not recwcr completely
from the injunes. He w.ll have to carry some form of disability for
the rest of his life.
-- The
...J ireason for this is that he was not treated
immediately.
Had
he
beenimmediately, he would have
, ---- 1 treated
recovered completely.
Can B said to have acted inegligently? The answer to this
question, to a large extent depends‘ on the issue whether B owed any
duty of care to A.
Thk d ‘h Weil Se4tdedLthat doctor B °^s a duty of care to his patient
llw H
6 her?e 9 contractual duty or a duty arising ouLf tort
not establXd3^5
Tu’
3 doctor-Pati^t relationship is
words of he S
Courtshave,!mP<>sed a duty on the doctor. In the
hoXro oth
seXs wi h L
d°CtOr’ at the governmental
\
f3 Pr°fessional oblig^ion to extend his
u'“5 ”n„ddu'
Sr'™' topfedltO ’"Ua“ons whe"'
the life””he
doctor does
treat Xn!’
Sp€akin9’ the doctor does not have a duty to
reat everyone who comes to him for treatment He has the
pnhXr L "L6? t0 treat °r refuSe' Theref°re, if we appty
Uiese pnnc.pes for the fact situation hereinabove mentioned the
Si"Ce be -- °w d
dX^Xe to " d LX*
duty of care towards A, wh.ch would require him to act otherwise.
WHAT IS THE DUTY OWED?
the slnrlme^X
HiS Patient’ in the WOrdS of
(Laxnsen v. Tnmbeck, AIR 1969 SC 128). The doctor, In other
11
! b'o
words, does not have to adhere to the highest or sink to the lowest
degree of care and competence in the light of the circumstance.
A doctor, therefore, does not have to ensure that every patient
who comes to him is cured. He has to only ensure that he makes
a reasonable degree of care and competence
REASONABLE DEGREE OF CARE
Reasonable degree of care and skill means that degree of care
and competence which an ordinary compe:ent member of profes
sion who professes to have those skill would exercise In the
circumstance in question."
At this stage it may be necessary to note the distinction between
the standard of care and the degree of care. The standard of care
is a constant and remains the same in all cases. It is the requirement
that the conduct of the doctor be reasonable and need not
necessarily conform to the highest degree of care or the lowest
degree of care possible.
The degree of care is a variable and depends on the circum
stance. It is used to refer to what actually amount tp reasonableness
in a given situation.
Thus, though the same standard of care is expected from a
generalist and a ‘specialist’, the degree.of care would be different.
In other words, both are expected to take reasonable care but what
amounts to reasonable care as regards the specialist differs from
what amount of reasonable care for the generalist. In fact, the law
expects the specialist to exercise the ordinary skill of this speciality
and not of any ordinary doctor.
Though the courts have accepted the need to impose a higher
degree of duty on a specialist, they have refused to lower it in case
of a novice.
Another question that arises is with regard to the knowledge
that is expected from a doctor. Should it include the latest develop
ment in the field and hence, require constant updating or is it enough
to follow what has been traditionally followed?
It has been recognised by the courts that what amounts to
reasonableness changes with time. The standard, as stated clearly
12
hereinbefore requires that the doctor possesses reasonable knowl
edge. Hence, we can conclude that a doctor has to constantly update
his knowledge to meet the standard expected of him. Further, since
only reasonable knowledge is required, it may not be necessary for
him to know of all the developments that have taken place.
1
I
i
We have, till now, examined the duty of a doctor in so far as
treating a patient is concerned or in diagnosing the ailment. 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 this 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 disclosing all possible
information in this regard. Further, this duty does not extend to
warning a patient of 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 other cases.
WHEN DOES THE LIABILITY ARISE?
Liability of a doctor arises not when the patient has 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 for only those which are a consequence of a breach of
nis duty.
Hence, once the
I* existence of a duty has been established, the
plaintiff must still pr<■ove 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.
■A
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 then that the conduct of the doctor was below this
degree. It must be noted that it is not sufficient to prove a breach
to merely show that there exists a body of opinion which goes
13
1
against the practice/conduct of the doctor. However, in the light of
the facts of the case, that there was a body of opinion supporting
the course adopted by the doctor, the scope of this judgement would
seem to be limited. For it is extremely unpalatable that a doctor who
is the only one who has adopted this course can still hold his own
against a body of medical opinion. The implications of such a stand
would be highly detrimental. Further, as doctors are entitled to rely
on general practice as proof of reasonableness, there would be no
merit in denying the quality of reasonableness when the plaintiff
seeks to rely on it.
Hence, except where there is a body of opinion in favour of the
conduct of the doctor, the fact that there is a body of opinion
contrary to the conduct of the doctor must be considered as sufficient
to prove the breach of duty of care.
With regard to causation the court has held that it must be
shown that of all the possible reasons for the injury the breach of
duty of the doctor was the most probable cause. It is not sufficient
to show that the breach of duty is merely one of the probable causes.
Hence, if the possible causes of an injury are the negligence of a third
party, an accident or a breach of duty care of the doctor, then it must
be established that the breach of duty of care of the doctor was the
most probable cause of the injury to discharge the burden of proof
on the plaintiff.
Normally, the liability arises only when the plaintiff is able to
discharge the burden on him of proving negligence. However, in
some cases like a swab left over the abdomen of a patient or the leg
amputate instead of being put in a cast to treat the fracture, the
principle of 'res Ipsa loquitur> (meaning thereby ‘the thing speaks
for itself’) might come into play. The following are the necessary
conditions of this principles.
1.
Complete control rests with the doctor.
2.
It is the general experience of mankind that the accident,
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 principle
is applied, the burden is on the doctor/defendant to explain how the
14
i
I-
I
I
,hc ab“n“
h.4:s^&e!s"ThS
a judge is not in a position to decide whether in the ordinary course
far aX’
XT
COUld °r C°U1C not have happened, as
felt is
fP
7atment/sur3ery is concerned. This reason, it is
ahXs h T C J°
aPp,iCati°n °f the PrinciPle as ^e court
always has the authonty to rely upon expert witness to help them
dec.de this question as regards medical cases. Further thj point
4
|
Xn‘th
PlTntiff iS Unabls t0 accurately pinpoint
sloerS JX XX !
'
he WaS unc°"scious (during
9 ry)
that he did not have a clue to what was going on. Hence
It would seem that a good case is made out for not virtuaSv
ipT/Citur66^1 CaSeS re3ardS apPllcaticn of
principle of rS
Normally, a doctor is held liable for only his acts (other than
hX °WV’?nT llabiliT)- However in some cases a doctor can be
X?
' Vi3 u an°ther P^500 Which Hjures the patient
e need for such a liability may arise when the person committing
comS tXth0' Z
1
9t 9,1 tO the Patient or that in
Z2
J" ? nOt breach6d any du^ A typical example
of a case where such a si uation may arise is in the case of a surgery
a/asZ
X
35 Part °f the team’ th60 his duty, Ts
T
1
advice or hTT
SE2Cia'iSt Skil1 iS concemed, Is to seek the
d^s rt°
T u3 X01-- He Wil1 haVe Charged his duty once he
d°es this and will not be liable even if he actually commits the act
if he actually commits the
which causes the injury. In such a case
to have advised him properly. If he did notdo^
thS Sen'Or
so, then he would be
noTcS: aStO
th^h h,
e
WHEN THERE IS NO LIABILITY?
A doctor is not inecessarily liable in all cases where a patient
in his case has suffered an injury. This may either be due to the fact
that he has a valid defence
rare. In this section, the latter l.e.'when’lhe^tienlta loitered an
bu'
15
a““ •» -
General Practice, is the normal usage of the medical profession
as regards a particular aspect in question. For example, doctor
normally use a stethoscope to listen to the heartbeat. This is normally
considered by courts as an indicator of what is reasonable in a given
situation.
The main issue in this area Is whether general practice is
conclusive proof as to reasonableness?
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.
Another factor to 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 in the case of the
former, it has been recognized by the courts as not being a breach
of the duty of care. It can be described as the recognition in law of
the human fallibilityJn..all spheres of life.
-
A mere error of judgement occurs when a doctor having only
considered, makes a decision which turns out to 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 be as follows:
A patient has symptoms which are Indicative of two different
diseases ‘X’ and ’Y'. 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 treats 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.
16
t
7
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 of
judgement and the doctor would not be liable for the injuries caused.
WHETHER A DOCTOR CAN DEPOSE BEFORE FORUM?
Undoubtedly, a doctor who is considered as an expert evidence
is entitled to depose either on behalf of complainant or aggrieved
patient.
ARE THERE ANY LIMITATIONS ON THE PART OF
CONSUMER FORUMS TO ADJUDICATE THIS KIND OF
ISSUES?
One significant information which is required to be noted is that
the above principles of medical 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
evidence. Time and again, the National Consumer Redressal Forum
has observed that, if a consumer complaint pertaining to medical
negligence is required to be adjuciated in the light of detailed
evidence, the consumer forum is not the proper forum but of a
regular civil court.
_ Needless to say, in the ambit of ‘Doctor, Consumer Protection
and Adjudication of Liability’ this issue deserves serious consideration
by one and all.
Standardization of professional care, is it a solution?
17
!
)
SYNOPSIS
)
quality assurance
r
AND
♦
r
i
Medical Audit
)
)
by
Dr.P.N.Halagi
Additional Director
Strategic Planning Cell
K.H.S.D.P.
Department of Health & Family Welfare
Government of Karnataka
Bangalore.
)
)
)
>
SUPERVISORY FUNCTIONS
Understanding the needs and modes of operation of the workers
)*
‘ whichZ' is »X8 Ws
)
>-
• Guiding him in planning his activities.
I
>
I
>
)
)
)
»
a8ainS',,,e consetluences 1 hey lead io and SOils aCo,
• Evaluating the outcomes.
•' Reewardi„hi,nhP'ar
“I”'"5 " *Of
Kewarding him for his work.
=»Penencas and
TYPES OF SUPERVISION
L Authoritarian and democratic Supervision.
Task-centered and employee-centered Supervision
»
>
>
98
1- Medical Audit .- Medical audit is now and
accepted method of evaluation of
hospital work.
Medical audit has been defined as an
quality of medical care-Professional competence,
salth°mpMe"ce'
uncover inefficient sZi«Tpoh"
'
audit cannot
accurate.
- - - .KXs
The
2. Need for Medical Audit.
3. What can be achieved by medical audit ?
(!) Improvement of patient care.
(2) Assessment of competence ofindividual doctors
y) Assessment ofjob done by hospital administrator.
treatment, iT se^f edSiom"
regards accuracy of diagnosis and mode of
4. Methods of Carrying out Medical Audit.
5. Certain Useful Indices for Medical Audit . d
indices and standards can be considered as useful"
ji
'V
S
followi®
. .(^.The^verage bed occupancy rate : 75
- (b) Average length of stay of patient 5 - 80 percent can be considered as top limit
- 13 days.
(c) Death rate : overall 3-4 percent.
Average post-operative death should not be more
than 1-2 percent.
(d) Analysis of how many patients treated and
out of them how many recovered.
improved, not recovered and worsened
m Sz
percent.
ixsxr cionsu,,ed when ,he
i>
d °bStetriCa' Cases 11 sho^ not be more than 1-2
‘’’haXX;" C'“r SUr8iCal' me<iiCil -
no, b, more
(h) Unnecessary surgery for example caesarian sections
The incidence of such cases
should no, be more than 5 percent at the most
JZXe rcent
°®-s
It should be
0) Frequency of staff confere;:nces.
It must however be clearly stated here
regarding the various indices by a Jose study^e!
our own standards
Attention is also invited to the various indices mentioned in
para No. 7, of this book.
99
I?-?
6. Conclusion
Medical audit thus offers an excellent opportunity to hospital doctors
to educate themselves, especially in view of the fact that the science of medicine is a dvnamic
one. It keeps them alert and skillful, makes them take more interest, and stimulates them to do
their best.
7. Medical Officers must be aware ot exact meaning of certain terms which are i; sed
for preparing hospital statistics :
(a) Gross Death Rate ;
(b) Net Death Rate;
(c) Maternal Death Rate;
(d) Autopsy Rate ;
(e) Admission;
(f) Average Daily Census ;
(g) Bed Occupancy Rate (B O R.) Ratio ;
(h) Average Length of stay (A.L.S);
(i) Bed Turnover Interval (B’T.l).
100
CRITERIA
in the facility which details
-l hcre is a written plan for the quality assurance programme m
i i
1
■H
The objectives of the programme.
a
The methods by which th.s is achiex e: •
.
ibe activlties.
b. Those indwiduals or committees respm^ e or
c. The wav m which the results are reported
.
d
U.e ev^uon o(
2 The quality assurance programme
in the facility include the following elements.
activities undertaken
3 Quality assurance
a Monitoring.
b Assessment
c Action.
d Evaluation.
e Feedback
IMPLEMENTATION PROCESS
/
I
1
1
%
s
sc
A. Develop a Policy
committee Structuie.
B. Establish a
Nominate a Quality Assurance Officer.
C
D Plan Your Approach
••
3 of Concern.
E. Wl,calcStarr
Identify
Problems/
Areas
F.
Method of AI1P[°,
G Choose Your
’. .
t of Timetable andd Collect
C-""' Results
|1 Document
Disseminate Results and Initiate process for Follow-up
1.
t
. 101
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^.OOTrkF^Oj •
" l
10-
^^S»Orf
ojjoaa rtdoj* xSonvj
W5O30 dt^ ^.sciark^Oc^*
RULE 13 9
(SPECIAL LEAVE)
odjDtn^ ^uDrfojj^
arfoojod
odjo^n^j^ ^dF(jj^j^0j33djf d^orf
OoOjDDD^ttid tra^ud^uO Bddvrarf,
- Jn Oj^jj ^a^^nkiadj
oojjaj,
^300#
aontfrt 15 o?3nvod rfjBdoojj^d.
11.
I
a^a^oua ^5a&r^ ad^n*
asfiLZB locu aonvj a^nF
ix&jaj.
12.
you
-S^ ^<<>30 Orf, (SPECIAL LOCALITY LEAVE) RULE 140
«0q«
^o^ojjkwj
•!
0Jc)3j^OJ0 SPSOOrt
oSojmjj
^a
*
jTOOdyFg Cfe? (CASUAL LEAVE)
ANNEXURE
- B READ WITH G.O.NO:FD
163 SRS 58 DATED 05-12-1958
^a^dood Oecfoo^ 15
«•
looj
njOo^ 7 O^no^ c8c3or1
• :4r
1^
4
•q.
^f
i^raas odn^sd deoad 10 oanvj aj^as^adj.
SaroQs dd ouju cxjjTEjd^ odni/J7)ood d<Osoj £jdj30u„.
crv*
dj^a.t soaj noJojjddd uif^a waa aoscJ wjr nasj-a*
csdojjskJ^ dJCSvraoj akrasusjcjj*
(AH)*
djaadojj dSFd ^aa^ojjo,, ^ooj sonv d<drran uoaj
dooejuRdo dkTdGModo*
43):;.
i
•5
(SPECIAL CASUAL LEAVE) ANNEXURE - B
W*
GSjfiJQ^7)O0J gStTSH
»<
rf*zj-3.a. adj avdot^^n
•5.
—
14 Oi^Wd
(soacn)^e.ojj
sjdj^ ^>gddd gjujoa
— 7 oantfj•
»
aa
yarfcto^srarf — 30
dvTSa^oJ^OtJBrf
. I
CN*
jp.
I.
ajiVa i^P^ad wyOTau^cs 30<ra3 gg^asdc
^jaoctan — 14 OiSrivj*
5^odj
uj6zfedaj ?w
a^u^n
?jbo
djraa^^ocran
— 21 o^nvadd, sarkra 505,30 ^Oonsnan -st c& djadooj^d.
I?
>
i
1•
A
(PROVISIONAL
PENSION)
READ WITH G.O.NO:FD 100 SRS 83 DATED 3-1-86
waan) oqjda da^oouy ada0t5rfja^duju t adaorf djjodjddooj
d^^Odj
®3d dd^^ ddaosood da^ooyaan ^oyd d^ddackSodjj dua^F
oo^do od^dnvdj< atduaFdrVaCdd Odao^asdOd odOodjo^,
odjad
dd^’S-j, c5^_3dddu^ a^du^ya^^*
2*
(COMPOSSIONATE PENSION OR ALLOWANCE) RULE 217 & 218
oajgOu
•
•:
:;
’
•
■•
-
.
■
c5^_3r3 •
•• • {■»
aso^ya Sd^a. dpd (invalid pension) rule 273
3*
•
woi^ojjocran dan) dvraao doctyrao^
dj^FGS^rTBO t
^_3ud
•
•
, ;• '
rf^cbtf wjda ddaddt? cr^ro^aod d^arO d<dn ruaodjo on oddoqsrdad
d^acO d^soart
dd^^dcydddj^ d^d^^todj d^t^cfo dsfyd do^drt
djocjadj akradcranj^.Q•
•
4-
■'•.•'
•
-•. ■
•
.
'
•
‘
iHl
aodja^ad,^ dq.33 (superannuation pension) rule 95 and
••■li‘
283 OF KCSRs.
58 ddr dodod^do^ akjaoOd d^arO d^^o d^^Cdo ^da^ododad d^arO
rv^dojood ad15’8_> CDkjaoO dodua^dd^^^ d^_yd^^ odFdanjya^d •
^d^’S_>
—odjo, oduad ^on^om oddj 58 ddrodo^ cSjaoda^a^d f <y 3ontf £jad
Odd odOad^'daOrt* zjOa^d* odd ; oojad dsarO d^^dd «d^ Odaos^
. aonv duadorfodj OddaOdoC?
eoyd d^ddo odd 58 ddr dSjaodud .
<aonv d)OOd £ontf ^ja^odj Odd< 5cyaaodjdan dd^^dkraodosa^• p.p
*
5* _a^o^ aa^
»)- 15 dSHpn^
dojod
uodjau^cran
'
(retiring pension) rule 28b
^c^ooj do^o aidj e^oBOrt doursoo £on$no3 :■
a0o3 ^eSjjOjj
Atdoouocs ad^3,?T9n ij'•
aaood wjj3j3 w^oo
^.sJododJ^ ^.sriioojBn (d^kSe.?/) odd oesr^a
j
■■*■•• j.’
5 aim?
^<jaaauana3dj*
aododu 285(l)(o)»
o) d^arO d^sddj 50 dsiF dOdud^dj^ rfjaodd doao d43'Qz5oooood
dd^^darwoJoacran 5 da^nv odrya ^.dododo^ rfdaon ^.Odd
dodud^dJ^ dja^y dOrwa dd^-S^ dJuaoduu «dodj^derarkEJdj •
aodudj 285(1)(o)
t?)
c
9
dTa_yO^^ d^arO d^^ddj 25 dd^ntf mrara d<d o$da SOdair
dodjd^do^ doaoOdod, dsa^o&acJo^ddcJj 25 ddF odrsa
of^da 55 ddiF dodod^jdu^ d^jaoddoo t
d^^Od d^doduu doDFO^^ .
dsardd Md^^ooood odd$do„dodj ^odjdodo^ doarc^ 3 ^onsooa
djjod o d^arO d^ddrt cSja^a^dj #jaujd odddo^ d^dojjoo
dd^^rtjaCdutfdj* dodjdo 285 (4)*
2
!2r-$
2
6-
waayaora ^a^^, d^aa
(extra ordinary pension)
RULE 384 READ WITH NOTIFICATION NO:SR.S 79 Dt.21-8-80
isersFO spscjsj
~e„sj^ojsnn a®*fc5 ^udojjoa ajcto ^oatnn,
rfjcls woni^oJjBcran, iraojje?
i?us ajgsoj e^ajqiE
?Jcicran,
ss^fo ^scw aipdnjB wjSsra s^fo snsoanjB
^3<$'8_>S<3dddj^ d<3cranj^dj.
7-
sdasra
(COMMUTATION OF PENSION) RULE 376 TO 383
OF KCSRs.
d^ro d^oOdj
drfoojjd dd^s, ^3dd nod^ dUUDOdOOtJ LOdU
yanddj^ dodudj 3800 dOddFd
odonooddO d0d3Fd^jD’g'v
zjcgjdj*
Oc.4 OOd^F^d Sd^^add yari5;3j^ ^o^f^cs o^oud 15 da*Fd
v do^o dud: doooo^dcranu^dj•
8*
5JUJOZJ dd.53, ^t3d
SERVANTS
(FAMILY PENSION) THE
KARNATAKA GOVERNMENT
(FAMILY PNESION) RULE 1964
R55aFO KP5CWJ Tjaoa^ ^doojo„ojoan wjsaa sa^a^^o aoao ao^a
s^O" eaaj ajjaaao osa ajaodooj oaooo a^soa a?d, a^jo «?oa
«S<L,S_, noaj aj5*tfj (18 a*Frwadrt) ajaododjana osa^s_, cfajo
sjsA^>j (21 asFd add)
d^aaa adoajoj wn5Fcranjaa_,d.
sjujou aa^a^ doaaaj^ tiss-ao^ sjujouc tzjd aaseod ajaa,
erarijaoj •
aua rpsosj “avj aarnerf sadjojjo^n wsf d<d ao„Ao aoao d<d
oojo^ojaan aj^aaaod;' ^j^dodj uao ado d^asa
50^A aajaaa
rfaoaa aooo„ o^aa Rraojaa^aan uy4aanja sjujosj dtaao aoao^aj^,
•saoO" oojagaj aadoodjae. 9 sjujou dcaRJaaj^ rfaaaa oooo„ tjtfj
ssfto 5ao wjsoa rPsoaj^ adjAaQd 65 asrotf -aodj^aj^ aasj
djaoaja ass q?ooo„ oojagaj djaodjat o^auanjgaj.
sod ajajJ aaojj ^ooa s^fO ?r>50oanojQi ^aoja aj.jaoaa as
oaa^a^ 3J5*$r! ^sja sjujou d?.3iSJ nc«^ ajadoojaa 3381-00
cj^nsrkRtfdtf^ou^d •
do„
9-
dOaTdo ^3,53^
(COMPENSATION PENSION) RULE 259 TO 272
iraoojo
odd djdQodjj 0dc)ofi wdddj^ ^.dojjod
adjnrfooj^cTDn «d<M ido^dudud osjrfoojjdj^ ^vHJdcicjnOdTJon, od<drt dOasud
<3c.3dddj4 A^scranuESdo*
IO*
r3030 rfjDdoQjud TUddDd (RETIREMENT GRATUITY)
RULE 291 & 292
ei 10 asF^os sadj ,Oma
s^fo jpsoarf d^osja
aooj ^f^afs
waSFya
yaaj adoojjA_,o0 aoosa 57.00 yarKranoja^d. *e.rt
srfoajja wssassj a^soa soavo no^ isi wjsja^ auaj, 2.5 o«n<?nja
d^dJ^OdOdJdjd•
«) ^sgoj ^dcaj^ojoonde. ajon djaoooo^ ajorfjD^a^o ^acaag
OodUUt3 •
PENSION CALCULATION SHEET
I. QUALIFYING SERVICE
Daya
Month Years
A. Gross Service
Date of Birth
Add retired age
Date of Superannuation
Date of Retirement
Deduct date of entry into Service
GroasM Qualifying Service
B, ADD SPECIAL ADDITIONS
i.
pecial Addition in respect of Govt.Servants
who have been appointed under Special Recruit
ment Rules (Rule 247)
11. Maximum weightage of five years are to be
I added in respect of Voluntary Retirement
cases (Rule 285 (1) (a)
lii.Military Service upto 05 years to added
vide Rule 219 (b)
C. DEDUCTIONS
a. i. RkXM Extra-ordinary leave
11. L.W.A. •
Counted shall berestrlcted.to
^lii. Over Staying of Leave
03 years in the entire service
Iv'. Joining Time
(vide Rule 244 (A))
v. Suspension
vi. Unauthorised absence
b. Minor Service (Rule 220)
c. Suspension confirmed period (Rule 250>
d. Dies-non (Rule 76 (3)
D. NET QUALIFYING SERVICE
• The
is earned
after -J
33 years Quail- •
x . maximum pension/Gratuity
- -----------tying Service and any service beyond this maximum limit is
ignored in calculating the length of service Qualifying
service should be expressed in terms of completed six monthly
periods for this purpose fraction of year in the Qualifying
Service should be reckoned as follows.
.7
Fraction of a Year
Leas than 03 months
03 months and above but less
than 09 months
09 months and above
No.of ccmpleted six monthly '
period (Halt - Years)
NIL—————
One
Two
. 2
-x
2
t -
E) EMOLUMENTS
(Stenographers, Typi
aca, uri
Typists,
Drivers,
"ckn^”0”1
I-rement
Interim Relief, (Vide Rule 296
to 298 Of KCSRs.)
—•—••a
A
|
,
FORMULA
Last Emoluments
2
‘
Net Q.S. (in terms of Half Years)
66
X
1) Pension -
Fraction of a Rupee should be reounded off to next rupee (vide
Rule 287 of KCSRs.) Minimum pension
Rs.1055 Maximum pension
Rs. 10610/-
2) Retirement Gratuity =»
Last emoluments X Net Q.S, (H.Ys.)
4
Maximum amount of Rs. 2. 5 Lakhs paid in Lumpsum (Vide Rule 292
Of KCSRs)
3) Communication of PensionPension
Commutation value expressed
1/3 (Lower Rypee tobe taken) X
12 X as No.of Years Purchasing
(Rule B80)
(Vide Rule 377 to 381 of KCSRs)
4) FAMILY PENSION
_ a* Not exceeding Rs.4050
b. Exceeding Rs.4050 but not
Exceeding Rs.8000
c. Exceeding Rs.8000
3 0% of Pay maximum of Rs.1055
20% of Pay minimum of Rs. 1215
15% of Pay minimum of Rs.1600
and Maximum of Rs.3381.
Vide Rule 5(1) of HOC
KGS (F.P) Rule 1964 read with GO No:FD
(Spl.) 1 pet 99 dated 15-02-1999.
5) DEATH GRATUITY
In thee vent of Death of c
a Government Servant in Service,
Death Gratuity is admissible
b.o at the following rates.
Length of Service
a. Less than one Year
b. One year or more but
less than 05 years
c. 05 years or more but
less than 20 years
d. 20 years or more
Rate of Gratuity
02 times of emoluments
06 times of emoluments
12 times of emoluments
Half , of
I emoluments
---- for every
completed six monthly period of
Qualifying Service subject to a
maximum of 33 times emoluments or
Rs.2.5 Lakhs which ever less,
Vide GO NOsFD 20 SRS 87(1) dated 17-08-1987
. . 3
3 :travelling allowance
TRAVELLING ALLOWANCE FOR JOURNEYS ON TRANSFER
01. Travelling Allowance for Journeys
on Transfer
02. Training
03. Journey’s Occassloned by Retirement
04 . Journey’s to AH and Examination
05. To Give Evidence
06. Recall from Leave
07. To obtain Medical Advice
08. Interview before the Departmental
Servicing Committee
09. Who die while in Service
10. Home Travel Concession (H.T.C)
11. Leave Travel Concession (L.T.C)
Rule 532
Rule 571
Rule 248
Rule 546
Rule 558
(556) L
Rule 4S4
Rule 559
Rule 571 A,
Rule 540
iK
Rule 549
Rule 558 B
read with OM FD 7 SRS 90
dated 06-06-1990.
1- —
i'
• • 4
-
4 :-
I'i)
TRAVELLING ALLOWANCE CHART
FD 15 SRS 94
2?'o I.' I • 238 A - OO "OlFD 4 SRS B7 Dt.lB-3-07
15 SRS 94 dated 21-9-94 and FD 1 SRS 99 dated 19-01-99.
No incidental charges with effect frcm 1-9-94 vidn
para 15 of
GD FO 15 SRS 94 Dated 21-09-94.
Cate
gory
I.
Pay range
Travel by
Rail
Tour by Bicycle/
Air
Motor
Cycle
Scoo
ter/
Car
Full
taxi/
own
car
a.10620 and
above.
1st Class Travel by 30 ps. 1.00/
3.00/
/ AC
_ Air With
per KM. KM.
KM.
in & out
side the
State.
b.9060 above 1st Class Travel by - do
-do- *doK
but below /AC two
Air■ Within
10620
tier sleeper) the State.
II. 5850 to
n
1st Class/
- do- -do- -do9059
AC two tier
sleeper
III. 4150 to
ii
1st Class/
-do - -do- -do5849.
AC Chair
Car
IV. Below Rs.
Ilnd Class
— do — —do— -do
4150
sleeper
Auto
Rikshaw
2.00/KM.
Subject to
a rr.xnimaw <
of Rs.4.60
- do -
-doi.
- do
i
do
rates of daily allowance
Cate
gory
I
B*lore
Half
Within
the
State
Munici
pal Corpn.
Other
Places
Within
the
State
Rule 464 halt
outisde the
State Delhi,
Ahmedbad, Bombay’
Calcutta,Lucknow
Madras, Goa Etc.
Other
Places
Outside
Rule 464
(Para)
6.1 Spel.
rata of DA
for stay
in a Hotel
paying Rates
at Scheduled
Tariff
Rs.
Rs.-
Rs.
RS.
Rs.
RS.
150
125
100
180
150
340
275
II
110
85
75
150
110
275
200
III
85
75
60
125
85
200
170
IV
60
55
50
85
60
150
105
. 5
5
\M
Cate
gory
Personal
effect
Transporta
tion of pe
by road.
Transfer
within the
District.
Transfer
outside
the Dist.
Transportation
of conveyance.
I
5000 Kgs.
10/ P.Km.
Rs.1200/
Rs.2000/
Rs.10100/. x A
&LabtfVBrtM©tor
Cax^
Car
3000 Kgs.
6/ P.JOn.
Rs. 900/
Rs.1500/
Rs.
Ill
1500 Kgs.
3/ J’-KJn.
Rs. 600/
Rs.1000/
IV
1000 Kgs.
Rs. 4450 -Mp^ercr
orcleabove/ Scooter.
below
10100/-
2/ P.Wn.
Rs. 300/
Rs. 500/
Below
Rs.4450
II
A
Cycle
Transportation of personal <el£ects, ln municipal Corporation
area
Rs.30
30 per
per JOn.
JOn. Category I to zv/ other Places^ls
Rs.
’’ .
~
per Km.
Transporation of personnel effects in^ x.Municipal
1U41xl
Corporation Area
Rs.30 per Km. Category I to IV other Ti
Places
-- 1 Rs.15 per Km.
INSTRUCTIONS FOR PREPARATION OF TA BILLS VIDE ACT 137
01. Gazetted Officer TA Bill
& 138 OF KFC
should be preferred in form KFC 22.
02, Non Gazetted Officers TA Bill should be preferred in
KFC 29.
03. The hour at which a Journey began and ended should always be
noted in the bill.
04. Purpose of Journey should be specially noted in the bill.
05. Separate bills should be preferred in
respect of TA on tour
HTC/LTC Transfer TA etc..
06. If the TA claims is not preferred within
three years it will
be forfeited to Government.
07. When once final TA claim has been admitted' no supplementary
claims should be pr^iarred in respect of TA (Rules 6 and 461)
08. Allowances such as TA should not be claimed
as a source of
profit to the receipant.
H.T.C. RULES 549
01. The concession is admissible once in 2
years calendar years
block period.
'02. The Government Servant should have
put kks in continuous Service
of not less than one year.
03. Family includes Husband, Wife and Children.
04. Controlling authority is the competent authority to
sanction ETC.
. 6
-:
6 t-
L.T.C. 553 B
01. Visit to any placd in India.
02. Only once in entire Service.
03. Minimum continuous service of not leas than 10
years.
04. Family includes Husband, Wife, 02 Children.
05. Controlling authority is
competent authority to sanction.
REGULATION OF DAILY ALLOWANCE
Up to 06 Hours
Exceeding 06 Hrs. upto ‘
12 Hours
Exceeding 12 Hrs.
upto 23 Hours.
No DA
DA
Entire absence period of frcra the
headquarters including.
Journey period counts for the.
purpose of d DA
Full
DA
If free boarding and lodgingw 13 providing k the DA la admissible,
if either free boarding or lodging is provided Sj da admissible.
(Rule 529 of KCSRs)
Guardinship Certificate issue I
Ccrumisaloner of the
District where Pension is admissible
to the minor Child where '
natural guardian (Father- Mother) is not alive.
No-Due-Certificate.
Last pay Certificate.
. . 7
7
ADVANCES
G.0.NO:FD 48 AHB 94, DATED21-10-199a
Amount
Princi
ple
Inter- Rate of
est
Interest
Eligi
bility
Article i
50 months pay
Rs.5 Lakhs
25 months Pay
Rs. 2 Lakhs
180 M
60 M
15.5%
05 Yrs
Service
209 to
215
36 M
24 M
n
16 months Pay
Rs. 1.5 Lakhs
100 M.
20 m
12.5%
08 months Pay or
Rs.25,000
Rs.7,500/Rs.30,000/-
60 M
12 M
11.5%
50. M
100 M
10 M
20 M
11.5%
12.5%
Bysicle Advance Rs.1500/-
20 m
10 M
9.9%
Computer Adva
nce
&.50,000/-
72 M
28 M
8.5%
Equipment
Advance
Rs. 6,000/-
24 M
Festival
Advance
Motor Vehicle
Repairs
Advance
Mvance of
Leave Salary
Advance of TA
on Transfer
Advance Pay of
Transfer
Advance TA on
Tour
Advance for
Medical Treat
ment in Forei
gn Countries
75% of Basic
pay Max.1000
Rs.5,000
10 M
HBA
Home Repair
Advance
MCA (CAR)
Scooter, Motor
Cycle Advance
Moped Advance
Tri Wheeler
Solar Water
Heater
01 month
Basic pay
50 M
n
M
Basic
218 to
pay
225
Rs.10100/
more PM
n
Rs.5325
Rs.1500 PM ! n
Physically n
Handicapped
2 Yrs. 3 226 to
times in
233
Service pay
below Rs.4450
Rs.10500
or more
Nil
238 (C)
10 M
12.5%
Motor Car
lumpsum
238-A
H
01 month
Basic pay1, .
t
Rs. 75,000/-
Rs.10, 000
234 to
,286
234
06 M
lumpsum
287
Convenient monthly
Instalments
50 M
08 M
7.0%
12.5%
239 A-l
05 rears
. . 8
—t
8
1^1
PREPARATION AND FORWA_RDAL OF PENSION PAPERS TO THE ACCOUNTANT
GENERALI
/
According to G.0.NO:FD(SPL) 83, dated 18-09-04 only
particulars in the proforma appended to the Government Order
shall be obtained by tihe Head of the Office, from the retiring Non-Gazetted Government Servant and Gazetted Government
Servant whose pay and allowances are drawn by him,
him. one year
before retirement and sent along with the other pension docu
ments to the Accountant General 03 months before the date of
Retirement of the Government Servant.
A Gazetted Government Servant shall furnish the particulars
in the proforma appended to the Government Order, to the Accoun
tant General, one year earliest to the date of his retirement.
The following documents in respect of Non-Gazetted Servants
and Gazetted Government Servant whose salary is drawn by the
Head of Office, should be sent by the Head of Office to the
Accountant General.
a. Form 7 duly filled
b. Service register duly completed in all respects.
c. Particulars in the proforma obtained from the Government
Servant (as per G.O.NO:FD (SPL) 68, CPP 83, Dt.18-9-84.
d. Two Specimen signature furnished in two separate slips
duly attested.
e. Two slips showing the particulars of height and personal
identification marks duly attested.
f. Three copies of passport size joint photograph with wife
or husband duly attested.
g. Declaration of non receipt of any pension and DCRG.
h. Declaration to repay any excess payment of pension DCRG
and commuted value of pension.
i. Statements of Earned Leave, Half Pay Leave, Commuted Leave,
Extraordinary Leave availed during the entire Service.
j. Declaration commuting pension in the prescribed form.
k. Calculation sheet regarding pension DCRG, Family Pension
l. Questionnaire duly answered.
(Given in Circular No:FD(SPL) 5 CPP 77, Dt.15-4-88)
m. No-due-certiflcate.
n. Last pay Certificate should be sent to the Accountant General
within a iweek from^the^date of retirement (Circular NoxFD(SPL)
14 CPP, 77, dated 24-06-77).
4) In case of death of <a Government
~
Servant while in Service
the following documents
-- have
-- - to
_ be sent to the Accountant
General.
9
a* Appll catfo,
"•• 9 :Kcsro (new,n for Family r
P^slon
*orm) in Tripi
b- ThrQQ
’i
Annexure
d
opfc
to form »c,
cate.
Qe of
duly
atteat-ed by.^aaport
.
Of
c • Death
a
Ga
2etted
Of^
^rtl^
Of the
d. Term ■£>.
oate ln Original. —-'■•-er.
^afmant
e. ServicQ , of *CSR s Presc^bed u’ndQr
Agister.
f. Unction
family
penslon.
°rder
for
Two cflips
Payment
Of Ggsg in
each
APpli
—cant ^Uiy
form 09
two
Of *CSRS>
sPecln>en ,
attQsted.
• Two t_
•
slips
s^gnature
showl
ng
r
i.
the
—cation ^arks
of ^ht
|
-1* Que3ti
and
°f the
°nnaire duly
•fPllej;?
Personal.
an®wered
^(SDL)
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director, of HW/JW
A a a 1, bi re 91 or (HCKlr^)
Aaal .-4 rec trr (AlD$;/
1i
ST- UliCH 1996
jL-3 working
W^ist
laluk
iyy
T
2 1uk ’level
as Prc.^ra^ie Off
ax leer/ dist. -'iedipgi
c
- - dicers/
icers in the
S'j r/re on/Dy.
^r .uedical
-Oirec rcrsL-g/
Cl.'C/Senicr
icer/Speo i
jptvisicr.sl JJ)s/ Specialist/
11
st/3uty
’ l.’o.j
.■rincipelr cf
?:'i-cic^L of
Officer
;-e c i ce 1 /Ler.tal
VFM Training
Scec id: st/
3 ? 11 eye s "S jpd t.
~2ryt7
/died
of tearhirg
Cclleja Cf
Officer st
spirals/
Nursir e/^c-n. Taluk Le v e 1 ■'
■-kief .'.can.
01 f i r e r s , 3 J
Officer/Li rec
(?i:r-/L£/ He d i ca1 r ff:_
tor i.'in-.o
Health OffiCo r car Het.
Ls.-jicn-jl Inst,
(8SA- UhiPT)/
Health lab
l”
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c f Ophthalmo-
w/h£SSsj/
^tVckccincL.
{5THM'lore.
Ji>. ,TB. H* lOYt! .
: 3
•• Jo ^prove the list of eandldatee
Iixspectore OJ14 other categories
SKhrect tP tU Nurtzth oE conituUeB
Withe Twt\U0l
Meet Ay
^overrpnmv.
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Sur.-aor. LRpU/
£D.
^r.i-acn .
cer( F-ycifCHl
Madiral
Officer (LTc)
Hedical C(MIT)/Li st.
Ir-Jinin=j
Officer .
5
"i |
j’uii pewer3
ors dry/
r3dic21 Cff!c-- Hediral
Cffi-
lenres.y
» hHos’-'i t??/
i rewers
’'
dt-Me the sfeff oe th#
thrh vesrs
i>xinum f><y of
I
For iimicd wW locsl todies
:r
the foreisr services rules KCSHs
to Cccuercial under takings (l)
,‘?..'flac' Gi --s-SIVJ/- the-current
-t-'i.-.iBUE pay cf the rejated onst
C}\SS_I Junicr bctile Grade in
r-’pl|aced).
rr.r=3 yea .”3
(r.or.-Gaze cred)
. . .2
f >
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2
3
b) To d.-put? for Training with:
India for Course not exceeding
ninety days (loth Gazetted Staff
and Hcn-G?.sc ctec Staff).
full ncwsra
J.
- .
To sairtion the lenuzation of i<onG r: z = 11e a 0 -.r, f i on Te a v< c re ry Lu ty
vi: t!:in the Str te .
2 )
To cn^‘,'’a tie Teachers and
Staff cn '.orcroriuG:
b) To epi*
.L_urlng •?pi acn i c s wl+rm_
th' rc i.v iir/ e nt r 2c 2 so?.ry - a nd
there i s n o tiLK- t o c o ca in
sort't: c«; ?f G?vt.i’euir:.} Officer
withx 1 a
r<?r_ 3.\f! orficir
of s.ruiioncd seal: of r.j.y r< m
e llo*.‘. ? !.l?
js an ar-»oi nl.m? nt
being s^rc xc- Oct; t. s in bit.; neo u sly.
• .
’
c ) To apr.cjrr
v.arcsrt.Tr.c Asst .Wardent
One year
Six norths
(Tech. Staff)
full pov/ers
full powers
-■<6.5,000/p e r in st.
each tine
0 f' 1'0:if)j t.iln,
5* lo sa no ci on expenditure on
a) -uner.l expense? as rer scale
laid do’.vn.
b) Public Lectures sna Lesons-uratiers
4
nil
^s.1,500/each tine
. 5
6
One north
nil
a s . 5 00/- per
e piaeni cs o f
o r: 2 r.’v e k
a ur nt ion
full powers
Pull powers
(Subject to rati
fication by UL)
■^ull Powers
lull powers
limiting to
I’n 11 powers
limiting tc
as.100/-p.sr boc;z us .100/1 per
body.
Hs.1,000/each tine
£s .500/~each
tine
Hs.500/- er.cr.
time
. .. .3
O
I[I:
J
1
2
5 c ■
^i^re'ehar-s' "
he^ 4<rS not C3used bv
‘' ii-1-
■
- - fL /_
j$ull power
j^a1VrCe^a^C--r^-3nt
■ -IlI
--ic.i js? oz -'—ray photo filns
■ /i’ll powers
4
,i”,nc
r
f.
ptF y^r.. •
-
.500/each time
full power
full power
full c'ov.er
^s. 10, 000/e^ch tia?
i?3 *5,000/e^ch tics
3s. ifO/- per
sarh pair .of shoes
ner i-.ira feint :1
a’cspital)
-^.200/- te
ir.Tate of I." rrogy
Hosnitnl par case
ner year
g. :^^ur-s ^r cc'nirol of FlOffUa
c’"-r u;idsr the fcllor.-ing Hen'ds? ■
i) Ccr.L cruet ion .-nd r’n-.irg of
'M?p
3.5-TIor cotnnr, -.rd Kcspit^ls
i i • Purch se / nd
carriage of biedicina9
co
full p o we r
ll
6
i?3.2, 000/c.3ch tics
3
nil
5
;‘S.2,5OO/ench time
.5,000/-
Ha.l^c/- n er *?s . 15 • z- per
-nrh aair cf each paid of
ahoes ir.-nie she?3 to
o.f i'e»:t2 1
irk?io Cf
Hcsnital and
i»? r. t? 1 Eq op i t.n 1
3s.20i/- por and 33.200/inmate of*
par pair of
leprosy
shoes, to
,
Hospi tai per irrates of
C n. 3? per yr.
ppresy Hosp
ital psr case
o?r year.
^s.2,500/-
-s.i.OOOA each
tir.e to control
plague .
iii. Dietary cl arges
. . .4
i
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- 4—
1
2
3
4
5
. 6
iv. j>isiEf-'cticn charges
v. Bedding anc clothing
vi. Other ir.cicental exoendituro
in Plague coups.
5. h.
io s-ucticn the purchase of the
follr.wii-g without reference to. the
steres t.ure? ase benartwent the
foil-?’..-:• r:a rirrhnse rules and purchasing
from Cover rr:-in t ur.a?rT?..'’ing wherever
-vail il L:
a. J>I-’I
..-ICGLCS
b. Lir.,?r.
•sin;;
c . jf
d.
•? .
clothing
-. nc eocker.v and other
: ? 1 ■; i t‘;n: •;.
7hi.c/^xhibi tion material.^
kniicirj k l\’.ig3 net supplied by
.•lad'cal Stores or rate Contract"
?. .s r? ?;ai re d urge r.t ly .
f. In strum 3! ts , furniture and other
ecuiomenta required urgently to
colleges, teaching institutions and
other in.* ti turi ona.
o2
g. Herbs apt other pharmacy
necessaries.
^ull Forcer
Full power
Ss. 10, 000/an.c’i an nun
-ks. 3,000/each annum
Full p o vx? r
Full c?■.•.•?£
-vs. 1/-lakh
n?r annua
-is . 1 0, COO/- r? = r
a rnum
Full pr.v.^r
“3.50,COO/p?r annum
?.a .25,000/par annuo
its . 5 i •00./- D3 r
da. 20, o.y:;/per annum
1(3.10,000/per anr.un
2s.1,OOC/per ar.nua
nil
Ks.2/- lakhs
nor annuo
Ke.1/- lakh
per a rr.um
lis.2/- lakhs
per annuc
ns. 5 0,000./per annum(for
repairs only)
Full power
Rp.lO/^- lakhs
par annua
f1 '
Hs.10/- lakhs Hs . 3/-lakhs
per annum
per •?. mmr
Full powers
nil
- <P
h) Other items of Hospitai
necessnries.
annum
I ■;
Full powers
Rs.50,000/per annum
“s.l/- lakh Rs.50,000/• per annum
par annum
. c;
m:
1
5-
.i •
2
I
6. G12SSWnrSj Ch-miTlgV/tiV "
-‘-■no.irtcry reesssariss to ' . other
nna otner Institutions/0 Colleges
3
?ull powers
fl
7. To S2retiCn ,?:<
renl icen—e
or repairs cf
I
ture on fixi'r.e
ana servicing
••-ri T H '' Urr-S Csn c ’
“oseopy
:r.d o.her rachinas.
b. 3 tor 1 libjtn/jii croec one's/
^frl^er-.tors and other
oouipmants.
c.
";nr!--"^/Cot3/Lock 2r
-rd - <’-Ji ..r. j nts .
)
nu ;Vri;5 ?f. Building in
u* -rge
-r^Gnr
rasrsct o. ^-ctricols/Sanitntion
and
r sunply etc.
tlon
Full powers
ro
V'I' Pull pcv/ars
1 ■ t
. , 't Full powers
■' ‘0
i
■',
' '• J
/'; 'run pczers
Kli
8.
:;ub<TG/ '/■
^nations
F Full powers
'■Jroar the c O Oc 1 5 ? J 3 th0r b1 n 3t 11 u t i ons
-i- 0
.
• u-l vuj
u
" J~
4 .
5
*25,000/each time
limited to
■^s. 1/-l-kh
per amum
Fs.50,000/each tice
limited to
l?s. l/-lskh
psr annua
s.10/-lakhs
psr annum
Bs .5/-lakhs
per annurn
^3.2/- l?.kh s
P^r annum
Fs.l/- lakh
, per annum
.5/-l.rkhs
per nnnuc
Fs.l/- i?kK
per - mum
hs..?A ickh8
poi* annum
l,..kh
^epartment.
Full powers
■: - j,
Fs . 10,000/per arruc
Ba.IO.OOO/per
nnnum
h3 .
, CCO/p3r -muni
?3r 2.71L2
Fa .10,000/P^r ar.r.u^
Full powers
Fu 11 oov.'er «j
^3 .500/-e2ch
time
Hs.5O/- e ?. c r.
t ir e
for
9. To sancf’cn
^'<per.clture out of poor
fund of the n ? sp i t e 1
.■0
•; ^11 powers
/ V
Pull povars
K. Tc
! Full powers
■iPuii powers
1
^3.1/_
6
nil
3.3.10,000/each time
limited to
Fu.l/-13kh
per annum .
'I
^3.19, COO/per annum
i
Full powers to
the extent of the
powers to purchase
these 1 terns . .*
9
l/C
£
-6-
2
r
12. To refund fee paid by stipendaries
who have been assured ful] freeships
l 'i -I-! U Crnesijipa clairead during
the o’.ce or the fcllcv/ing year.
?
Sunrl.y of Uniforms as per
eraser iced.
-Gtu~ of ?sot: ntinli iy certificate for
woino o.irnnd nt ores ov/r. cost for
r:clic-1 treatnenT with an undertaking
rot to
Medical re ioiburserLsnt.
• io cc!?lc-n:n ].in-er and Glassware and
L.itro-ns, •vnicn nave cocor.i unservicable
b-' ’hiir
r -> n: to-nr and tc order
3
4
Full povers i
Full powers
I-'
6
5
Full powers.
15
Full cowers .| : Full powers
Full powers
.•yj <
■ ‘
:l
Full rowers •i'• .1
nil
j >i
Full newers 1 i, Full pov/er 3
!|
■
Full powers
t:i.i2.r Ginn'>3-:1.
■* -
i
cnndn.-ii ijistruj snon :r.ci
i srne
ate.
Full pv.’ers
t i.
Meuicd Journals (Library)
Full pcwars
'Tull pcv/ers
Full powers
a. ir dep;t2 staff for instruction
ssflinary, werksh'-ps, training
cr any course (within the State).
Full powers i ■! :Full pnvars
Full p ? v/c r 3
b. Cat uhe State within India.
Full powers
___
'Full pnW?rs
less
'‘ithan js.1/~lakh
itench tizie.
:I
lass than
4C,000/~
ench tirce
Full powers
for Linen
d
Matrass.
1? s 3 t h a n
1,00 0/- e s c h
t ime
■<
•• T
4"
•i •
■I11
•2-
•L'
i «■
. . .7
i'll.*’I.''
/
'•!.■•
-
1
2
_
r
.
jj. _ _
■ ■
1
19. Purchase ?•:<. prrcluctir-p. cf fila
16 -r 5^
2nc Vi dec fii^g
3
.'Full p" \73rs
hf■ 0.
20. ■^chibi - ir r. 1.3. Mysore Lasara Maj-r
LVhibi bi-r. r" yr a cxi e
5
6
^s.3/- l:-ikhs
per annum frr
purchase cnly.
lHs.5/- I'lkha
le.Tch tins
21. rri— ing
■:
-f publication rec^rts/
1
ui.idlin^s.
4
i<s.l/- l?.kh per
annua
;Pull p^v/era.
i'
.
3
‘•Hl ;
•
>
■
(JCYC-? .TJ.iT-Xk;)
Intern-jl Firinci?! Auviger
Hailth inu Fnmily Uelttr? Lentt
■ i:T
'••
ji’.f
/CCvY/
I
'
.• hp/xjXtA- ■-
• ■i
j1.'1 ■
for Dlrocttrof Health & FW Services.
-
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T
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1
—SYNAPTIC botes ON BUDGeT
MANUAL BY
_ SRI.VTLWANATHAN
-SHef^codunts offtc^-™,., _
advisor
VTC£sf b * lore _
The Karnataka Budaet- Ma™, i
the PinMce De?arOTent fogr
and Departments cf the Secretariat 1
010 ru;es
Estlniat-n5 Officers
1-^'’
examination of the Budget Estim +■
S PreParation and
°ver. expenditure to ensure that^rt^k
^^^eguent control
5rant1S kept ^thing the authorised
I
Annual Pinanc^i
Statemep t:
«t Of the”XDtCle 202 of
Ot the Constltt'«.on of India a state£^of the State'~~for
two house3 of the
Statement or
"Annual Financial
Budget” ?
The receipts and disbursements of th =
are shown in the "Annual Financial stat
S
Government
parts, vi2I_
tatement" in three separate
I. Consoiidated'FundYbf-the State,
II. Contingency Fund of the State
HI. Public Account of the
state.
i)Consolidated Fund:
All Revenues received by the
raised^the state Soee^nt Ma all State Government, all loans
'
--ernment in repayment of 1^^ moneys received byAhe
ie Consolidated Fund of the State'. one consolidated Fund called
ii) Contingency Fund*
In pursuance of
Article 267(2) of the
India, the State
^egilsature h*s established a Constitution of
which i3 in the i
contingency Fund,
of^an imprest and is intended
to EX3vgg
Provide advances
-^-^±M£gjiHfore^^
re
course of a
year, pending
its
------------- -arising in the
_
9
j
_
ts
t
d^fl^^y^^egiiature
law.
by
iii)Public Acccxxnt
The Public Account of
the State Pertain-
to all public
Cont..
^0?
moneys received by or on behalf of the State Government which
are not creditable to the Consolidated Fund of the state.
Disbursements from the Public Account are not subject to the
vote of the Legislature, as they are not moneys spent out of
the Consolidated Fund.
Division of the Consolidated Fund
The transations relating to the
Consolidated Fund are
accounted for in two different divisions, namely:I. Revenue -Consisting of sections for
Receipt
heads (Revenue Account)
and
Expenditure Heads (Revenue Account) n
i) The division^tevenue is the account of current income
and of expenditure of the State met from that income.
The income
is derived mainly from taxes and duties, fees for services
rendered, fines and penal ties, revenue from Government Estates
such as Forests, Grant—in—Aid from Union Government and other
miscellaneous receipts*
ii. The Section Receipts Heads (Capital Account) in the
division Capital shall deal with receipts of a capital na tn re
which cannot be applied as a set off to Capital Expenditure.
The section Expenditure Head(Capital Account)" is the account
of expenditure incurred with the object of either increasing the
concrete assets of material and permanent character such as
construction of buildings irrigation projects, or of reducing
recurring liabilities^
iii) The Section Public Debt Loans and Advances,
etc.
comprises loans received by Govenunent, loans of a purely
temporary nature classed as Floating Debt, such as Treasury
Bills and ways and means advances as well as loans classed
as
permanent debt and loans and advances made by Government.
Division of the Public Account
There are two main divisions of the Public Account,
namely:-
I Debt and Deposits and
II.Remittances.
The first division comprises receipt and payments, inrespect or which Governments Kg acts as Bankers receiving amounts/
which they afterwards
repay and
■;:?Xlna..out amour. -3 which
they ,
rec^r i.e.state
Prwaent r-und, Insuran<:6
^nd,Depreciation and Local
Funds and
Civil Deposits..
Permanent Advances etc. "7^7
etc. The second
cc„prl3„ mere
adjusting heads
under which appe a r re,„ltta„=e3 Q£ cash
Treasuries and
transfers between
different accounting circle,.
The transactions
Of Goverrment art classic.
different functions
rapreaentlng maJor aivl,ion3
of Government,
into
th.
activi'ti
Grouo_jA :-General
Services <covering
—
services such as,
defence, police general
administration,
etc,, which are indispensable to the
existence of an organised
State and cannot be
conceptually allocated
to particular groups of
beneficiaries.
Group's ; - Social and Community Service
s covering activitie
associated with the provision of basic
soeial services to
consumers, such
as education, health and
social security services
-Groups*
Economic services
dealing with activitife8s or
assistance provided to agencies in the
fields of production and
trade, such as
agriculture, industry,
power, transport, storage.
comnunicatio ns etc.
Group •p*
and Advances#
Grants-in-aid and
con tri buttons and Loans
PLAN & NON-PLAN
_______
The Plan and Non-pUn
Non-Pl
an components of
variole
lan
provisions for
; aricus programmes,
activities
programmes.
and schemes are to be shown
against each sub-head in ■------separate columns.
At the sub-head
evel, the provisions for plan
-i
expenditure
are indicated
distinctly for :-
I State Plan Schemes,
yI.Central Plan Schemes,
111•Centrally Sponsored
and
Schemes.
Revenue receipts are
classified
Tax revenue,
3
Q
0
nd er the ^ol-rowing sectors;
Non-Tax revenue and
The sector
ana contrltu tlon3
T“ reV'5DUS
the £ollo.„-ng
ner sectors:
Con td♦.e
9'
a)Taxes on income and expenditure,
b) Taxes on Property and Capital transactions,
c) Taxes on commodities and services.
The sector Mon-Tax
revenue has the following three sub-sectors:
a) Currency, Coinage and Mint,
b) Interest Receipts,
Dividends and Profits,
c) Other non-tax revenue.
Introduction of New Major & Minor Head stA list of authorised major and minor heads
of account is
given in Appendix VIII.‘ The intro du ctioTTFa
The introduction
new major or
ntinor head and abolition 0^
or change
of ]nomenclature
of
change of
---------------- any of the
existing major or minor heads require
the prior approval of the
President.
^.reparation of the Budget
Budget : -Thp
»ms XI
bY
and for
'
...
5 purpose it has power to request
the Departments of the Secrets^ a-t- u
EstimafafeXTX"Secretariat, Heaas o_f Departments and other
u..u„9 oc£lcers
fttrnl5h „aterlii on-the
estimates are final 1
tk. u
,
*‘uicn me
on matedAl '
’
Heads_of Departments in turn deoend
ate.ial rurnished by District and other Officers who collect
revenues or incur expenditure.
Thus the“ds
of Departments
prepare the estimates on the basis of the
material furnished by
wiT
°ffiCe” in
of the Heads of
accounts
^.th Which they are concerned and forward -them
by prescribed
dates to the Finance Department in
the forms supplied by that
Department 2^ earlier.
Proposals which will have the effect
of reducing or
increasing the revenues, otherwise than in
pursuance of authorised
codes, or rules and proposals for new
expenditure should be
submitted to Government separately in proper time
and they should
not be taken into account in preparing the departmental
estimates.
T) rr .urxt
provided for in the Budget,
~ y-
The ,'Accountant General has
no direct part in the preparation
B of th Djdget estimates. He, however,
suomits estimates under
ee r tain he s
or account and renders such
assistance as may be v
contd...5
r<iasonably asked for by the
Finance Apartment.
Presentation of Budget to
the Legislatxi re :
. )
The Finance Departraen-t
consolidates the Estimates
®r< embodying the decision
of Government and
prepares: I» Summary Statement
of the financial
toe budget year.
Position for
TI. Detailed estimates of
receipts and
TIT. Statement of
estimates of expenditure.9rantS followed by detailed
These statements include both
1 expenditure charged on- the
consolidated Fund
stat®
Siind of
of the
---- ouate and <
expenditure not so charged.
Authorise t i o n of Expend!turet
Except where the expenditure is
covered by standing
sanctions or where necessary powers
have been delegated to
e| Administrative Departments, Heads of
-nets authorities In this behalf with :• Departments and subFinance Department, provision of funds 1„ the
th concurrence of the
Budget itself
conveys no sanction to the sub^rd) n a
expenditure.
ate authorities to incur
Acccxintg or Actuals of
a
ear
Accounts or actuals of
a year are the
and disbursements for the
amounts of receipts
1 year
beginning on~ fjr3t April ,
^xxxxxEKfrkTttsxgMd
ano endin
following, as finally recorded <
day of March
recorded in the books of th« a
General.
or the Accountant
Administrative approval
1= the
opp^ova! of a scheme,
proposal or work
formal approval or
acceptance thereof hy the
authority for the
Qf
competent
incurring
expenditure thereon. For
every work (excluding Pefety works
-o obtain/ in the first in3.
authority of the Administrative
and .repairs) it is
the concurrence of
the competent
department requiring the
work
except where the power of
administrative
approval i3 delegated
to the Head of the
department
or
other
departmental
I
Administrative approval is
officers,
not
by
itself
sufficient
,
to take UP work unless
au thori ty
there i8 provision of fUnds and
sanctions
technical
corded to the d,etailed estimates.
I
4
-6-
-V*
Administrative Department:
V
A
nepat^nt
for
J
under consideration is assigned
for disposal under the Rules of Business.
Annuaj^_ginancial. Statemont or Budget
Annual Financial Statement
or Budget means the
statement of the estimated receipts and
the expenditure of the
state in respect of each financial
year to be laid before the
legislature*
Appropriation
•
Appropriation means the amount authorised bv th- a
□
^wiwrisea by the Assembly
for expenditure under
a major, minor or eub-head or other unit of
appropriation or part of that amount placea „
“
°£
disbursing officer.
e dlsPosal °= •
Budget Estimate
Budget Estimates are the derailed
estimates of receipts
and expenditure for the budget
year.
Charged Charged expenditure, uimigea on revenues or|
charged on
charged on the consolidated
fund means such expenditure as is
not subject to the vote of the
Assembly under Article 202(3)
of the Constitution of India*
Demand_ fqr_ grant:
Demand for grant means a
Proposal made to the Legi-slative
Assembly on the
recommendation of the Governor for
expenditure
from and cut of the consolidated fdrid
of the State on tile Service
to which the Demand relates
other than charged expend! tu re <
Detailed Head
Detailed Head nieans the lowest
accounting unit under
w'nich the transactions
of Government are recorded in the
accounts
and is also the lowest
unit for which figures are given in the
Budget Estimates*
PJ-^bj rsing Officer:
mone-*
■--
r-f.ng Officer- Every Government :
crvant who draws
treasury on bin3 foL dtc!AI..,
'■'•‘i.'it is a disbursihg
Contd.7
*•) -
-d-
^3
Officer ( a Gazetted Officer
who is' not the head
of an Office
and who draws only his own
pay and ;allowances
from the treasury
is not included in the term.
Financial
gar or Budgpt
ear
Financial year or budget
year means the year commencing
on the 1st April of
one calendar year and
ending on the 31st March
next calendar year.
Grant
Grant means the amount voted by the
Legislative Assembly in
respect of a Demand for grant.
Major Head
StatCe
::xa
P
rrr£or the ™ -
ncI disbursements of the
Minor Head
Minor head means a head
subordinate to a Major head
or a
Sub-Major head.
New Services
New Service means new form of
a service
°r a new instrument
of service Which-is contemplated^
newly for the
first time and
which was not contemplated at the
; time of preparation of the
Annual Financial Statement.
Re-approoriat-fon
Re-approrpriation
means the transfer by a competent
o£ savings from one unit of
authority
appropriation to meet excess
under another unit within •
expenditure
■the same grant or charged
■Token Demand
appropriation.
Token Demand is a demand made to the
Esgiig Legislative
a nominal sum (Rs. 1,000
generally) which it
proposed to
meet the expenditure from
savings out of t±ie sanctioned
budget grants.
A ssembly for
The expenditure in
respect of which a token demand is
presented can be incurred
only after it is voted by the
Assembl y, HxEent
Legislative
Contd..
.A
Vote on account
Vote on account means a grant in advance made by the
Legislative Assembly, relating to the Voting of grants and
passing of the appropriation bill before the commencement of
the tudget year.
Voted expend!ture:
Voted expenditure means expenditure which is subject
-to the vote of the Legislative Assembly under a. Article 203(2)
of the Constitution of -India*
KLSCTION OR TOtj)
~NT
TfJ FO
----
^•^WTHYLNJAYA SWTY
^acu1 ty
ATI, Mysore
Article
distursing
over
3 o-F KFC, ^Hentions that,
the
officer (DDO)
subordinates
irre9ulari-ty.
He
in
drawing
5^cxjId keep an
adequate
order
to
avoid
cannot plead that he
deceived by his subordinates.
and
check
■financial
“as. misled
or
7^-- Preverutii
-.-^^.-Despite taking
of
Precautions,
also
■to
-fraud
might takes place.
detected' in shorter
taken 00 the concerned ot-Ficial'
taken - to prevent it.
Such
time and action
frauds
to
be
5 and also action to
be
therefore DDO
has to be
cautious.
extremely
!
^^gligence
or
incorrect
handling
o-F
ignorance
' implicatims
give soope for fraud
or xt ^y result in
■financial
area
irregularity.
procedures^
decisions
^aragefnert.
receipts, -pendituce, deposits
will
^7 kind of and
f^raud ^ay takes plaCe
of ■financial i
or
in
any
It ^y be in the
area
of
advances, etc.,
oil
The
cash
inflows
various
forms.
The
properly
update
to Government
responsibi1ity
takes
of
assessment list, rise
place
in
IS
to
DCO's
the
demand
in
the amount in time and to see
that
the
amount is actual ly Vemitted to the government. For
this
time,
he
collect
has
records.
to maintain CCB register
and
other
connected
The amount will be collected in the office
the parties, will be asked to remit the amount
to
or
directly
Bank/Treasury and to produce the copy of chai lan
to
office.
When cash is received in the office,
the
cash
receipt
has to be issued in the K.F.C. form No.1.
This
cash receipt books will be supplied by Government
press
- to heads of departments -and in turn Heads of: Departments
will
supply these receipt
books to subordinate
DDO's.
At all the 3 points, the stock register of receipt books
will
the
be maintained. ODO and cashier will have
to
sign
cash receipts and DDo cannot delegate the power
of
signing the cash receipt to the subordinates. First
the
cashier
will
sign
should sign the cash receipt and then DtXD
the cash receipt. The receipt number of
receipt
has
to
be entered in
the
cash
the
book.
cash
Whi le
signing the cash book DOC must ensure all these aspects.-
ter
without
ODO ha5 signed cash
an immediate
tampered
the
receipt £or
smtry in the
cash '-eceipt by aiding
Rs.400-00 both in
as
^rds and
figures. R*® has also
try • in the
cash book -for RS. 400-00
The
DCO
resulted
the
cashier
the
signed
the
in embezzlement
notice
cash
v^hich
Of Rs-360?-00. This
audit a-Fter a lapse
book
the
blindly,
comes
in
remittance book,
looking into
made an
cnly.
book
has remitted
cnly Rs.400-00
remi ttance
cashier
C3Sh h001*-
was
the po^er o-f
o-F
2
years.
into Bank.
signing
blindly signed
by
to
Even
c ha 1 ] an
vuu,
DDO,’
Tl-e
on
and
witteut
tampered
.y ?^d -
the procedur,
e» no traud could have
taken place.
^^^iigence on the
part o-F the
much . more
Nhere
Pointed
DDO' s.
tihe
serious -Fraud.
duplicate
ar>d that
There-Fore
^ch kind O'f traud.
We, even
EDO's, may end
UP. in
come
cash receipt book
duplicate cash
DDO should be
across
cases
has
got
receipts are
signed
very alert
to
by
orevent
?! P
A few cases are only cited here. It is not possible
particular
predict that fraud will takes place in a
to
way. Some times there will be no solutions or guidelines
in the rules to prevent -fraud. The alertness o-f mind and
and
accountants
reports
auditors
o-f
Studying
and
with
discus si'On
the
auditors will be very use-ful
DCC's.
In cases, where, DD's or cheques are received, only
the
cash
acknowledgement has to be issued and not
it
is
mentioned that, cash receipt may also be issued -for
the
in
When
receipt.
the
cheque/DD,
manual,
Departmental
o-f
issued.
But the entry to be made in the
be
may
receipt
then the cash
receipt
receipt,
cash
"This is subject to realisation” . The o-f-fices with small
cash
an entry’ can' be made straight-in ’the
transactions
having
o-f-f ices
book
with the number o-f DD/Cheque. The
huge
transactions,, should maintain the day bock in
the
-form
o-f
A-fter
the
"Cheques
encashment
Care
adjusted".
only, entries to be made in the
should
cheques
received and
be taken by DDO's -for
within
o-f
trans-fer
o-f
book
to
the due date and -correct
cash
bock. Even when there is large cash
the
totals
the
ot
the
day bock
to the cash book.
day hock to cash book.
transactions,
day
will
be
Care should be
taken
by
eri-Fication
o-F
-for
each
DDO's to check pagewise totals and
carry forwarding of balances,
book.
the ‘encashment
o-F each page/date wise -from day
entries/to tai
transferred
cast}
■From page to page and -From
I
I
In
t^e cash day book
c 1 osing
the
Receipts) ,
] ance of Rs-10,002H2)0
Opening
Ba 1ance
cn a
on next page
Rs -1, 9ZO-00.
The
page
6 and 7
only. The total For
Rs-20,
6 shours
Articular
<Page-?;
entries *3r”e Tor*
^9^ 6 and
^ith a short
entered in
h3ok and the
When
that,
cheques/DO'
s are
accounting
o-F
the cash book.
P3yment,
departmental
Habl & "For
manuals.
that,
produce
as
per
the
they
sho<jld
local hanks.
should ask the
challan. Even cn
copy
should not be
acted upon by issuing
is ascertained
that the
1 -icences
oF
Party
to
and
to
c ha 11 en,
etc.,
ameunt is •actual ly
k
case
o-F
directly to the Bank/treasury
the c°Py oF
to. the treasury,
in
to
da te
pen a 11 i es
Payable on
the amount
I
due
-Far as
Possible,
this is not
Possible, DDO's
remit
should
o-F cbeques/DD-s after tl^
are
day
- O^ ..^e.Xrn?r»t
accept the local
cheque and DO'5
.IF
Both the
received, DDO's
The> ’^10 also
they
7 as
Fs-‘?, 003-00.
!he^e.:datel
encashment
day
by DCO. This is
- make it ciear
o-F
es
suoervisicn.
“ "
Governmen t.
shcvx-]
pa<5e 7 shcxso on
cash book a-e
^atly signed
a clear case o-F
failure o-f
date,
^articular
This Rs-1?.000-00
t.'ne
remi tted
<1
U'?^en accepting currency notes frcm the party,
care
H
■fake
lodged
with
should
be taken, by not accepting -Fake notes.
notes
are
pal ice
and
received , complaint should
to
the
bank/treasury
■For
matter should to be
the
reported
controlling authority.
Uben
to
amount is sent
large
remittance, su-Fricient precautionary steps should oaken,
It
Adequate security should be
person.
and
re1iable
ensured.
Wherever
experienced
be entrusted to
should
necessary police help may be sought.
T a-
amount
that
the responsibility o-F DEO to
is
is actually credited to government account. Tfcis can
ensured
with
by.
consolidated
o-F
accounts
will
send ’ the
proper jnccithl.y__reccnci 1 iaticn
treasury.
o-F-Ficer
Treasury
The
treasury’ receipt and DEO to
accounts
with this schedule.
appeared
in
his
I-F the
books and not
be
the
compare
receipts
accoun ts
in
treasury
appeared
receipt
accounts,
should
veri-Fy
in
detai 1
and ledge complaint with police and
in-Form
the
control 1ing
imrediately, . he
author!ty.
The
Departments
wi th
sma 11
receipts transaction, can depute a clerk to treasury -For
rec one ilia ticn
work .
The
person
rec one i 1 i a ticn
work
should
not
employed
be
-For
same
per son , emp 1 oyed__ -F.or^recone-irl-i a tion= wor k-shou 1 d
tt-a^sarne^pers^-i, who has taken the amexant ror remittance
to bank or treasury.
- — ■*•««** 9□NMEWV MTS»rv
o
This
case
n^Pitals,
Twice
in
bank.
The
send the
and
pertains to 1972.
they
a
Earlie
used to collect 25
tooth,
they used to
Ps.
remit
in
district
per
Patient.
this
amount
to
used
to
medical superintendent
o-f Hospital
{=>^Cf'i to remi t the
amount to bank with a
remitt-ance book. The
cha 11 an
proved that,
used to tear
the
the challan
remi ttance
book
VMCrk
76.
The
and put duplicate
and
pocket
was done -for the
he
bank seal
on
cash.
No
the
period -from
1972-
^bezzled amount
was arcund Rs.4.5
1akhs.
In
cases detection o-f
■fraud is possible
only
through
monthly
> which the medical
4-
such
n°t dene.
Only
receipts
13
management.
specifically
direct
•
cash
remittance
area
of
how
It
■fraud
illustrated in the
is
not
possible
wi 11 take^ Place.
area
to
of
say
It
is ■the
DCO r(
yarding movers-) *of
res^ibility ot
■from
Now
- few cases are
the point of its
realisaticn to
its
actual
to bank/treasury.
wi 1 1
1TO(< into
Precauticn to be taken in the
expenditure management
1-e-, cash
Prevention and detection
o-f -fraud.
°u tf1ow
and
•
cheques.
takes place
wi tlxJravia 1
Funds
I
and
bills
be
wi thdrawn
for
works,
establishment
expenses
like
salaries,
...I - .
i-Ur-
will
Funds
con tingencies,
through
to
. government money, -following are essential rules have
be -followed.
1. Budget allotment
2. Competent sanction
3. Financial Propriety
4. Purchase rules
5. Accounting
Finally this.wil L.be -followed by. ..Audit.,
ESTABLIShTEM- BILLS
against
payments
regarding arrears i.e., possibility o-f double
paymen ts,
The
DCO
should
be
cautious
drawal of the leave encashment twice in a singli
block
non—feeding of retirement date to the computers,
draws1
on
bills against the DOO
forged
account,
discrepancy
regarding entries when compared to entries in cash book,
tampering
accounts
the
in
of
acquittance rol1 , non-entries
service book, evading
the
pay-fixations,
advances,
wrong
undisbursed
amount etc., This list is
leave
adjustmen t
embezz1ing
not
of
the
exhaustive.
But the negligence may result any kind frauds.
Pr-e-cauticnary steps to be
taken are as
■Fol lexvs.
1.
I
Thorough
acquittance
’eri-Fication of arrears with
-□Us
and cash book,
to
reference
avoid
excess
to
or
double payment.
2. When signing the
leave encashment bills, the
to be made.in the service register.
3.
Awareness
of
the
retirement
bate
of
tries
the
sub
ordinates.
of accounts, to detect the
encashment
fraudu1en t
of establishment bills and other
contingent
bills.
5.
When signing the
cash book
book, h\aS to be ^eri-fied with
6.
in
acquittance roll
words with bisbursement
undisbursed amount,
the
cash
acquittance.
Ch every page, total in the
recorded
7.
every entry in
to
certificate.
be
For
separate register to be maintained.
As anb when the leave is
sanctioned ar> entry
made in the service book with attestati
ion .
to
be
S3
in installments to be given
o-F advances
6. The recovery
watching
for
wise
be
maintained
by
advance
name
page number ■For each kind of
a
a lloting
and register to
number
progressive
are to be noted
entries
clear
• retirement
or
transfer
On
recovery.
it's
LPC
in
by
consulting this register
in
done
rules. In case of doubts.
relevant
opinion
the
be
should
Pay-fixation
9.
the
of
Accounts
accordance
the DCC's
may
Treasury
and
Officers
with
officers.
CONTINGENT BILLS
and sent
The sub vouchers attached to the bills
to
should
be
voucher retained in the office
treasury
or
stamped
with
payment
to prevent the possibility o-F
"paid and
cancelled”
after
immediately
double
payment.
The genuiness of sub vouches i.e., bills received.
from
verified with utmost care. The
DOO
the
firms should be
should
ly.
see
to
that the amount is actually paid
Wherever possible, it should be paid
by
payee
cheque.
with date and signature should
Clear acknowledgement
ce
impression
is
obtained
from the payee. Wherever thumb
obtained
it
persons•
cheques.
shoal d
be
got
attested
by
known
It is suggested to issue only the account payee
L ''
’s.oaa j.a xPo;snD
smi
’s•oaa
Ipuosjsd
^94
aq
ut
Pinots s>|ooq
«oeIS „nb^3 Xq pjM
I Hm
‘oaa xq AUOa-<Tp -g.y o:)
Passed
I^Tqrur
(sas^
S>pOM
90ns uJ
‘ P^U-jaDuQj
vua^sXs
aq
ST
-^BA
6uruunj
ST
ewuc^j
^unoDop
sqq 5uTXed uaq^
■p^oj |Oi.
>“ ’HO. Ja„™ J-° aaueuaquTeuj
Surp^eBaj
ajnpaDojd
*-ll
pue
3 ^S-J-JTO
e_je
pure P^^Uoj.
-Jap<ja}
xri
‘srnq
XI-|eiri3T4_Jed
aje S-Jo5pay
a^Tpu&- xa
flTM
IBT4<-re;sqns
‘siriq
u^;tm
Htm squrC3=e
s 4 uauj/ed
*auop
^^CXtre
sas
Pinoqs
OTO
seS ’3-'r>pa2)Q,)d
■|-c,T4eoonE>
^BiSpnq
aAy;ej;sTuTtjpB
pue
e
^T^OUtps
I^^TLqza;
■ --JnpuT- oj
3tfUTOdX3 s3SFi
'x; T-rac^ne
5uTno^uc3
pabpoj
auop
^uas
Pincxqs
^9 cq
seq
oq
lJOT41E^^oq ut
^reidmco ‘pnejq Xue
1-oTqeDT>TJaA
PaiTeqap
Pup a=7iod
ST S-J3q4
‘squro^
'^-‘nsE’a.jq
^4 UT 5uTjBadde
squnaaap
squroDDe
s.OGO aq;
Tseq Arinuoaj
aq
94 th
6 '•
Pinoqs.
UT &uT_jeadde
6UTPJB&aa _s
P3ITDcosaj
aq
BSTM
sar-jqua
^94
pue
Pincqs s4Lnco3P
Lo x-"‘'SBa_jq
4 ou
94 tm
^-'nqrpuadxa
■psy^T-jaA
snrq pcre S-jaqonoA
‘>poq
qspp
^94
qns
6utu5ts
/
ua9M
Ilk
DDO's should be very careful when signing t.he cheques by
not giving scope to -Fraud, which may taken olace in
the
form o-F addition or alterations. Cheque writing machines
may also be used. When signing the cheque
■ entry in the cash book to be
corresponding
entered.
SAFETY CF
The
lock
cash should be kept in cash chest with
system. One key should be with DCO and
double
the
other
key should be with cashier. The duplicate keys should be
lodged
in
required,
book
treasury.
Cnee in a month or
as
o-F ten
as
the cash balance should be verified with
the
ba 1 ance; The" ca^H~c’hes t~ has-be fob
em
cT
to
A
the interior walls.-
Regarding
Bank//Treasury
taken
transportation
to
o-F
o-F-Fice, sufficient
care
by employing a reliable government
necessary
departmental
-From
cash
should
be
servant^.
If
vehicle-may be used,
when
the
the
DCCI
should obtain nOT-paYmgn_t^cec.ti.f.icate_frem treasury,
by
amount is large, with police escort.
When
the bills sent to treasury is lost,
requesting him not to make the payment. cn the-lost» bi 11.
Thon
the
treasury.
duplicate bill may be Prepared
and
sent
to
1
I
if
*
When thj
cheque received frcrn
non-payment certificate has to be
wi th
Then
Wt*)en
in-Forma ticn
obtain
‘■specification
cash
cheque has
received
complaint has to
to
special
CurclAasc?d
should
the duplicate
the
lost/stolen,
trorn
to
the
the Bank
be
the
lost
cbtained
Bank
is ..
lodged with
Police. The
be sent to Head of
government order to
the
Department
re draw
the
to
amount
materia Is has
P^cxzured,
compared
^on t i cried
exercise is not done
wi th
the
sampi
in tl>? supply order.
pnoperly, fraud
--~=: ~T—“f-S-XT o'—_•
$
obtained
a cequest to bank
not to make
P^ /rnen t co the
cheque.
When
trEfasury ,
»__ ,
y ls Tost,
it
Or
wi th
IF
this
I
V*
^y takes Pl ace.
Co
-1
k -
(
In an o-f-fice,
cash
orderly
the section
superintendent aleng with
in collusion *ith the
treasury
n\anaged to obtain- the, treasury tokens
bills,
.. ,f rfupiicate
on,
of-ficial
Theyuprepared the
the. DCO
account. i and' ■Forged the
-CV
^nature of?’OTfic^/r^^\;USed:.-to
sign- on behalf of DCO.
They
■1
-
___ rmanaged-to^4X2tain; 'the c'hpni.o-oirAn-^equ“ ^rcm:
.w;, ?.fr. -‘irtu
encashed -from bank.
the
.
<•.rr
1.■- ' -c,
This they' practiced -for
treasury token number
years.
^as not verified in
of-fice, due to the colusion of
- -
treasury • and
treasury
treasury officials.
kind
of fraud has taken place and the embezzled
was
m
terms
of
detected----- early,
few crores.
' if
the
i his
rr-onthly
could
could
This
amount
have
reconciliation
accounts was done by DCO with treasury, or
this
Even
of
subsequently
have been detected through'
internal
audit
has not been detected by
in ternal
audi t
system.
This
sys tern,
mainiy because the staff
audit wing are not pr*ofess.icn
borne on the
internal
<31 acccxjntants or auditors.
BQ-E CF INTERNAL AUDIT
*
Role of Internal Audit is to provide the
financial
cate to the management slcxigwith performance report.
provide
for
al 1
advise and also conducts the
ccncurrent
the wings of the orgar, j sa tier .
departmen ts,
following are Hy,
internal auditors.
In
impartant
It
aud i t
govemrren t
I
1.
Comparison
Department
a 11 o tznen t
by
of
expenditure
nt accounts
figures.
3. Condui
lcting of
Ringing
rule and
return ^rom
Propriety
to the notice of
hqd
irre<3l-ilariti
etc-, with
suitable
5.
In eonsultation with the
the
mi scl assitications,
DZ)O' s
to
the
trom
monthly basis.
Compariscr, .
4.
Head
to DDO's with the
return of
DOO's on
2
o-f
AG ’ s
a,JPi t.
about
the
financial
^ggesticns.
AG' s sta + -f(
^i-fication
setting
right
,
of
ohalIans for
toucher and
detection ot Traud etc
k
uc-> has to be done
by
a^dit. system?
- ^.c.
It is the
see that,
the
'Professionals
To
reSponsiblHty Qi
eternal Audit
in the area of
conclude, the DOO
the inflow
can able to
and out-flow
Who is aIso DOO'
wing sta-f-f
acccxun ts and
should <21bABys
ot cash
detect ^nd/or to
15 tilled
to
up
by
eye
on
audit.
keep a-,
■and materialSj
so that he
Prevent the t^aurf.
de tec t. kms
^4
• -)
national aids control
S)
PROGRAMME IN KARNATAKA
OBJECTIVES:
- To initiate major effort in
the Prevention of HIV transmiggj
and to launch expanded
Preventive activities.
- To slow the spread of HIV
° as to reduce the future morbid!
mortality and impact of saids
.
PROGRAMME INTERVENTIONS:
lo
To attain a satisfactory level of
public awareness on HIV
transmission and prevention.
To develop health
promotion intervention
groups,
among jpisk behavio
To screen majority of blood
units collected for blood trans
fusions.
2.
3.
4.
6.
Tq decrease the practice o-f
,
To h
,
,
practice of Professional Blood Donations
To develop skils in clinioei
and Counselling and PsycioTJoSZ'?60'1' Healbh EdUcation
positive persons, AIDS^atients and^? tO HIV Sero~
pacients and their associates.
To initiate strengthening of STD Control
7.
To monitor the development of Hiv/AlDS epidemic.
5.
below:
1.
The Components of National AIDS Control
Programme are as
programme management
°f State
if’
Cell
ii. Formation of Empowered Committee
2.
1•E•C o (INFORMATION, education and
COMMUNICATION)
3*
SURVEILLANCE AND CLINICAL MANAGEMENT
4.
BLOOD SAFETY
iii. Zonal Blood Testing Centres.
5.
S.T.D. CONTROL PROGRAMME
6.
training programme
k
■
i
2
There are Eight(8) AIDS
functioning at the following
Stir veii lance
Centres in the State
pl aces:
1. AIDS Surveillance C
Dept' of Microbiolo.gy,
Bangalore Medical
iege, Victoria Hospitalu Bangalore
2. AIDS Surveillance Centre
-.’- > ' DePt. of Microbiology,
Kasturba Medical r
r
College,
Manipal
7
3
t
AIDS Surveillance Centre,
Neuro-Vi^logy. National
Inst, of Mental
Health and Neuro-Sciences,
Bangalore,
i4. Aids Surveillance Centre
D
ept.
of
Kiarobiology,
Mysore Medicai'Cdiege'
9 Mysore
5. AIDS Surveillance Centre,
‘ Of Microbiology,
Karnataka Inst. of Medical?ept
Sciences, Hubli
6. AIDS Surveillance
Centre, Dept,
Dept, of
of Microbiology,
Vijayanagar Inst.. of Medical
Sciences,j Bellary
7. aids Surveillance r
Centre, Dept. of
JJH Medical C0lleg;,"5^-;r“- Microbiology,
f
8. AIDS Surveillance Centre Dent«.R. Medical Celle"., Ja^a^ Microbiology^
1
.a .nd th2JCe arS 10~Zonal Blood Testing Centres functioning
in_the stat_e-„at~the; forijowing -placesf.
!. Blood Bank/2onal Blood Testing Centre
K.C. General Hospital, Bangalore
*
2 . Blood Bank/Zonal Blood Testino Cont-rp
Kidwai Nemorial Inst of n 5 entre,
, nl
, D ,
s . of Oncology, Hosur Road, Bangalore
3. Blood Bank/Zonal Blood Testino Centra
Karnataka In3t. of Medical I ^entra»
US'-, or neoical Sciences, Hubli
4. Blood BankZZonal Blood Testing Centre
Kasturba Medical College, Manijal
5. Blood Bank/Zonal Blood Testino Centro
M.R. Medical College. GuJbXga
''
6. Blood Bank/Zonal- Blood
--- 1 T®sting Centre,
Kasturba Medical College,
Mangalore
7. Blood T'‘
“
Bank/Zonal Blood Testing Centre,
Vijayanagar Inst.
r _tj <of Medical-Science/ Bellary
8o Blood Bank/Zonal Blood
HSIS Bosnia Hispltil/C^^or:"1”-
9. Blood Bank/Zonal Blood Testing Centre
Command Hospital, AIR Forceg
10, Blood Bank/Zonal Blood Testino Centre
JN Medical college, Belgau^ Centre'
...3
3
'The Blood Banks
and Di
STD CUnlC8
tO Government
major Hospitals
District Hos?ital3 in thQ Sfcate
strengthened by Kay of
PPly of sophisticated equipments and
laboratory supplies,
.ervieX5^13153 an<3 drUgS enablinVhe in3tit^ic
to improve
The AIDS Survey-J-^nce
11
Centres
j
Centres
activities for Surveillance p„rposas Sant
7/P HIV S"”"^
purposes,
gnostic and research purposes
\
lllance, Ma.
research purposes.
are takl„g up screening o£ Bl^al 7
T’'’tlng
taking up screening of Blood
safety0
eS f°r
transfusion
I»E.c. activities are ^ing intensified to create awareness
among the public about AIDS Prevention and Control through Health
Education materials. Radio
advertisements and Doordharshan and Nev.
Paper advertisements.
The existing Blood Banks
attached to Government Hospitals
and Private Commercial
Blood Banks are linked to the existing Zona
Blood testing Centres
creening of Blood samples for HIV befor
Blood .transfusion*
-oOo-
c
k
•:
I
HIV TESTING POLICIES
As per guide lines orNmional AIDS Control Organisation Governn.ent of India, the lolloping
■E
Four types of Testing procedure is followed:
1.
2.
3.
4.
1.
Voluntary Confidential Testing
Testing for Surveillance purpose
Testing for Diagnostic purpose
Mandatory Testing.
VOLUNTARY CONFIDENTIAL TESTING
Tire Voluntary Confidential Testing is done at Voluntary Blood Testing Centres (AIDS
Surveillance Centres), by giving pre-test Counseling and post-test counseling to those individuals who
approach voluntarily to know their HIV status.
Tie 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.
TESTING FOR SURVEILLANCE PURPOSE
The unlinked anonymous testing procedure is followed duly adopting tlie 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. Sampling 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 Ire subjected to testing by one type of test kits, tlie positive samples will be again
subjected for a-second test with different antigen principle. Tlie positive result of second test will be
considered as HIV Scro-positive. This kind of study will be conducted twice in a year. Tlie test will be
' done at Voluntary Blood Testing Centres (AIDS Surveillance Centres).
3.
TESTING FOR DIAGNOSTIC PURPOSE:
This test will be done at Voluntary Blood testing Centres (AIDS Surveillance Centres). The
samples of Clinically suspected cases referred by Physicians/Doctors will be tested for confirmation to
diagnose and manage tire case. Here three types of tests will be done using different antigen principles.
The first reactive sample will be tested by a second test and the subsequent reactive sample will be
subjected for third test. If tire sample is reactive in the tlurd test it will be confinncd as HI V Scro-positive.
The result will be utilized for AIDS case diagnosis and management.
vW
4.
MANDATORY TESTING
Mandatory testing will be done at Blood Bank to ensure Blood transfusion safety. All Blood units
Collected for transfusion will be tested mandalorily by one test only either by simple Rapid test or Elisa or
Spot test. If die result is found reactive the Blood will be discarded. Please note that there is no identity of
Blood donors, die Blood dial is collected for transfusion is tested.
places:
The Voluntary' Blood testing Centres (AIDS Surveillance Centres) are located at the following
1.
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, Daksliina Kannada District
4. Mysore Medical College
MYSORE
5.' Karnataka Institute of Medical Sciences
HUBLI
6. Vijayanagar Institute of Medical Sciences
BELLARY
7.
M.R. Medical College
GULBARGA
8. J.J.M.Medical College
DAVANGERE
and
RE-EMERGING INFECTIOUS DISEASES:
MALARIA J.E, PLAGUE, AND DENGUE FEVER
Dr .K.RAVIKUMAR
CHIEF MEDICAL OFFICER
REGIONAL OFFICE FOR HEALTH AND F.W.
BANGALORE
or^threaten to increase in the near future.
The emergence may be due to the spread of a^new^agent^or^the new
recognition of =^J^^gionaTreV dTsVase^hepatitis C, lyme’s disease,
XSh
and na.acode Infeetaons.
The factors contributing are :
Climatic changes
Building of irrigation canals and dams
Trade and transport
Deforestation
Social practices
previously
diseases are those infections which were
The re-emerging
or decline in
have appeared after a period of disappearence
known but h The main factors responsible are cevelopment of antimicrobial
malaria in Rajasthan
incidence.
- insecticide resistance in vectors like the re-emergence of
resistance or
'b'rMWo» ol P^Uc MUa
“hich led
' results
in “
changed epidemiological
or 1-in India. Population mobility i —
plague
resistant malaria. The important re
i---patterns of disease e.g. multi-drugpluyue,
cholera, anthrax, multi drug
Merging infectious diseases are plague,
, tuberculosis, malaria, leishmaniasis,
resistant salmonella infection,
t__----- cryptosporiodiosis et^..
filariasis,
microsporidiosis, lymphatic £---------
MALARIA
of malaria seen in the
of the country. The
sixte
■
. .l neceSsitated radical changes
disease'was at its peak around 1976 which uModified Plan of Operation. This was again
in the NMEP giving rise to the 1----------
followed by very significant decline in
malaria incidence all over the
country.
From 1983 on wards, the total nxilaria c
cases in the country has been
around two million per annum, touching the
lowest
million in 1987 and the }peak of 2.51 million in 1993. incidence of 1.66
The proportion of
P.f. showed gradual and consistant
in 1995 with
reaching 43.35* in 1991
With the peak
peek leeching
The disease has shown re-emergence in the
states of Rajasthan,
Gujarat, and the North-Eastern states.
After launching of NMEP, the
the heaths due
recorded during 1974 and the peak 1122 deaths to malaria were first
epidemics in Rajastan , Manipur, and Nagaland reached in 1994 due to
deaths recorded due
to malaria were also high reachingJ the figure .ofThe
-- 1012
--2 during 1995.
MALARIA PROBLEM IN KARNATAKA:
Malaria is one of the
Karnataka.
The
disease was at its peak in
cases
reported
in
the
state.
It showed steady decline till 1984 when it
was about only 30,000
cases.
During the year 1997, the total
.reported
case
incidence was about
1,80,000 for
state, Plasmodium
r'
— the
—---vivax & P.falciparum are the two species
of malaria parasites prevalent in IL
Karnataka. During 1997, about
about 46,000
P.faclciparum cases have been reported.
-• During the year 1998, about 1,19,000
total cases and 26,000 P.f cases have been reported.
Indigenous transmission
of malaria does take place in all talukas
J of the state.
However it is a
serious problem in only about 12 to 15 talukas of 6 districts?
The districts Kolar, Bijapur, Mandya E
Bellary and Raichur are the most
problematic-districts. In 1998, these districts
-J
together contributed to about
55 % of malaria cases.
About 143 primary health centres/project areas have been recognized as
high-risk areas.
Malaria is a predominantly rural problem in our state
unlike in some other states,
n the earlier years, the-malaria problem used
to be more in the western ghat
. areas. Currently these areas are free of
malaria and it is the plain irrigated
areas that are mainly affected. However
the towns of Mangalore & Bellary are problematic for malaria.
Control measures :
Anti-parasite measures :
iLagn°S1S
treatment (EDPT) is the main strategy
This is to be achieved by intensified surveillance activities.
(1) S-URVTrLLAVCE OPERATIONS IN
IN NMEP
NMEP
:• The cnrvoi 11 =r,<- 6
aim at an efficient case finding mechanism
aid adeouaMTlt^h
and adequate
treatment.
active
surveillance
and“’(b^sL^
and (b)
Active surveillance involves ffOltJ1,lgh^ly visits by the male health worker
to each household and collection of blood-i smears from all current fever cases
and those cases who had fever since the
previous visit. In problematic areas.
and where male health worker posts are vacant.
the female health worker also
contributes to surveillance.
He will also encuire about any visi-r^
u
they came. ----He will ask about the yme** —1 '-°rs to the house, the place from where
movement history of the members of the family
since his previous visit. These points
are necessary to find about the origion
of the positive case or its spread. At
the time of taking blood smears it
should be ensured that only sterile- H*
Hagedorn needles are used to prevent the
spread of AIDS. The blood smears
sre to be sent to the laboratory at the
earliest.
Passive surveillance is institutional
surveillance whereby all the fever
cases attending the outpatient departmentt are screened by taking blood
smears.
is1 a specialized form
o£ surveillance
surveillance whereby
whereby in
“
i
of
such
institutions where laboratory technician is available and microscooe^^facilities
exist, those cases which are clinical’v
microscope racnicies
screened for malaria and radical treSl^n? is Xsti6
uxeaunent is instituted immediately.
Fever treatment depots
. can
. . be
. set
in those areas which are remote and not
easily accessible. An intelligent person like a Postmaster, school teacher,
Anganwadi worker or a community health guide is taught to take blood smears
from fever cases and give chloroquine tablets as per a prescribed dosage,
Drug distribution centers are similar <centers where the person is not in
a
position to take blood smears, but only issues chloroquine tablets.
All the blood smears are examined at the primary health centers by the
laboratory technician and positive cases are given treatment.
Considering the expected number of fever cases in the community, it is
targeted to collect blood .smears
----- " to the tune of 12% of the population during
an year.
In passive surveillance about
----- 15% of the new outpatients may be
■ expected-to™have fever and so the same is-set as- the--target for'blood smear
collection.
Treatment schedule:
-hetLJ^fTn
JreSUmin<3 that
^ver case can be malaria, at
the time of collection of blood smear, chloroquine is administered to all f^ver
cases as per the following dosage.
AGE-WISE DOSAGE
Age in Years
mg. base
No. of
tablets
<-l
75
~T77~
1-4
150
i
5-8
300
2
9-14
450
3
15 & above
600
4
In High risk areas, .Chloroquine and Primaquine are given for all fever
cases as per following schedule.
2U
AGE-WISE dosage
Age in years
_________ First day
Chloroquine
Primaquine
(mg base)
(mg base)
Second Day
Chloroquine
(mg base)
75
Third day 1
Chloroquin
e
(mg base)
37.5
7.5
150
75.0
300
15.0
300
9-14
150.0
450
30.0
450
225.0
15 & above
600
45.0
600
300.0
<-l
75
1-4
150
5-8
Chloroquine should always be <administered
’ ' ’
after food only.
With this
dosage, the toxicity is minimized,
Rarely
gastric
irritation,
nausea.
vomiting, headache, pruritus, blurring
of vision etc may result,
When
chloroquine is taken regularly for
months as with chemoprophylaxis' for a
prolonged period, ocular damage with
neuro-retinitis, pigmentation of skin may
be seen.
(b) Radical Treatment: To achievA
chloroquine alone is not enough, as the persistent staa^ of
lna^arla'
cause relansA^
r-> d -p-ji 4 —.'-nt stages of the parasite can
Therefore primquine is also given inTo^Tna^Ton
C?1OrOquine'
treatment with the following schedule
chloroquine for Radical
followin^lge-X^scJeduL^^rom^econ^darto^i^dHv are 9iven as per
is given as per following age-wise. IchedulS
y'
AGE - WISE DOSAGE
Age in Yrs
<-l
1-4
5-8
9-14
15 & above
Tablets Chloroquine
(150 mg base)
Single
No.
Dose
Tabs
75
^77
150
i
300
2
450
3
600
4
Tablets Primaquine
(2..5 mg base)
.Single
No.
Dose
Tabs
2.5
5.0
10.0
15.0
1
2
4
6
P.falciparum:
Adult dose : 1500 img Chloroquine in three divided
daily doses (i.e. 600 mg
each
on 1st day
and 300J mg on 3rd dav)
n .
- & 2nd day
-----+ single dose . of 45 mg
Primaquine on 1st day.
The above dosage is for the adult.
should be as per above table.
R.T in high risk areas:
In children the daily dose of drugs
In high risk areas, p. falcioa
treatment with 1500mq Chloroou^ne
nOt
not be given RT, because
primaquine single dose has air-adv been m
6
9iVSni ffor 3 days and
i^-aay been glven Wlch presumptiveJ treatment .
•
In high risk areas, P.vivax c—
'
cases would have been (given
3 days k/J_
presumptive
treatment with 1500 mg Chloroquine
'
—,
„
do UXJlIk?
, -•given
Thererore,
further Chloroquine need1 not
be given but Primaquine is to- be
for
5 days.
Primaquine should not be administered 1 _ 1
to infants and pregnant woman. When a
pregnant women has malaria, only chloroquine
600
delivery and full Radical treatment given
^9 is given every week till
- —i after delivery.
The drugs should inot; be given
1W^XJ in empty stomach,
epigastric distress, abdominal pain etc
Ho
Rarely anorexia, nausea.
.
PD deficiency, primaquine may cause etc
hemo^
In those persons with G-6
urine and cyanosis.
hemolysrs which manifests as dark coloured
In problematic areas, where
la~ge number or
of cases are encountered, for
operational jreasons
--the radical treatment
days with primaquine giveni in doses of 30 for vivax cases is curtailed to three
mg., 30 mg., and 15 mg.
P.falciparum
mass and fo^n
c t
is tO be donefche
7th For
dayall
follow
up'sme^ tTTo' bTtakTn
iS
positive for s’chitonts of P.f, ait^e
,
tor
d°rugsall
like^
p.f cases. .If such smears are
“ Suiphadoxine-Pyrimehamine can
USE OF QUININE:
is the drug of choice i
of
specially cerebral malaria.
Slow infusion in isotonic fluid V 5 %
s^ould be given intravenously by
J dextrose
saline
three times a day
7?%™
8 h°Urs' The dose is
10 mg/kg maximum of th.
bay.
it
can
cause .--injected rapidly because-‘.of its cardiovascular r
SeVere hyPotension, if
activity. It can also
cause hypoglycaemia as it stimulates secretionsuppressant
of insulin’from
cells.
pancreatic beta
should be
also cause
Anti-Vector measures
Residual insecticidal spray :
IS being phased out and use of Malathion
w
be mg sought after. BHC
poor acceptance and resistance problem a
been Very llrnited because of
synthetic pyrethroids have been introdn^n
gri_oup cf compounds namely
a trial was taken up with Lambdacyhalothrin ^n t th6 prograrn- In Karnataka
y «iocnrin m two selected PHC’s for about
three years which has been shown to be rpma
Deltamethrin and Cyfluthrin are hPina
^markably erfective. Currently,
Tumkur districts. These have proven to hT t" Hafsan' ^hicka^agalore and
Rin-emHrAnman<-,i
Pr-^en to be extremely effective and safe.
Bio environmental control measures •
becauseeSofUathenSiei^etv^tableSIreasisCtanc>e
proXT17
Alternatively, trials done in manv carts
C°V lnvolved’
conclusively proved the effect-’ veness of thA
COuntry by 1MPC have
measures. In Karnataka, the field statiJ’ nf mpc SJOenvi;°™entaP control
Chickamagalore and Hassan districts to demon t- t- kS wor.'<ed ln the K°lar>
the personnel. The mainstay 0- thi^Xo^s d T" d
Reconnai sanrp nF ^11
••
method is detailed Geographical
control measures for
breeCln<? Places and planning suitable larval
uuiibiui are
measures
Lor each variety
variA^v of the breeding
.•
methods
:
place. The different
1) Source reduction measures
2) Use of larvivorous fishes
3) Use of Biocides namely Bacillus
thurigensis and Bacillus
sphaericus
4) Use of expanded Polysterene beads
Impregnated Bednets :
__
In different parts of the country, use of bednets impregnated with
synthetic pyrethroids have been shown to be very useful.
Malaria Vaccine :
.dfVelOFrnenC. °f.an effective malaria vaccine represents one of the
most important strategies for providing a cost-effective
currently available malaria control interventions. To date, ] addition to
relatively few
malaria vaccine candidates have
progressed to clinical and field trials.
Much of the research activity
over the past 15 years has focussed on the
identification of unmodified parasite, antigens to be formulated in
traditional adjuvants such as alum, This is now changing as new perspectives
to producing modified antigens are developed, together with new strategies
such as DNA vaccines and ]novel adjuvants for human use. In addition,
considerable experience has beeni raccumulated in the design and execution of
clinical and field trials for malaria vaccines.
DENGUE FEVER
Dengue fever(DF) has been known in India for a long time. Though the
virus was first isolated in Calcutta in 1945, extensive epidemics of DF have
been recorded since 1963.
DF is
caused by four antigenically distinct
dengue virus, types 1, 2, 3, and 4 belonging to the genu/ f 1 avivirus'^-'the
family Togavindae each producing a similar clinical illness. The virus is
surveillance programmes. These pprogrammes
should be capable of rapidly
identifying suspect cases of human
i ’’
-.1 plague so that these individuals can be
promptly treated and emergency measures
acquiring the
the disease.
disuse”’7^
tO Prevenc other
persons zrom acquiring
All 030
’ ^ii suspect cases should be isolated
for at least 48 hours after t
treatment begins, to reduce risks of human to
human transmission (pneumonic
Pi=gue cases~ should
--- - be isolated until
U11I-- spurum
cultures are negative).
cases
should
also
queried
about
.
.
about their
whereabouts and activities
the incubation period, usually 2 to 6
days, ]but. rarely as long as curing
10 days,
to determine likely exposure sites or
sources of infection, Individuals who
have had significant
contact with
pneumonic plague patients ((within 2 metres) ■’
' ' L_
should
be
advised
of their
risks, monitored for illness.
and offered prophylactic antibiotic therapy.
Those who have had only brief,
contact at distances of 2
unlikely to become infected, but should be informed ’ or more metres are
risks and
monitored closely during[ the
the’“CeeT“f71 lowi
week
following theS
Surveillance personnel should also
oerform
ePtial exposure.
also Dro^
perform environmental investigation at
likely exposure sites to determine
• - risks for ueLe
rmine
the potential
other
’”’"2 probable.source
Pr°bable source of infection and assess
persons living in the area.
All suspect
plague cases should be reported to national' health
authorities
and all
laboratory confirmed cases must be
u
WHO, Geneva, Switzerland, accordinn
fd thr0Ugh aPPropriatp channels to
Health Regulations.
9
requirements of the international
Animal based surveillance
levels of Y.pestis infection 1..programmes should be capable of monitoring
in mammal and flea populations and rapidly
indentifying epizootics in important
-- rodent species. Prompt detection of
rodent epizootics allows control
measures to be implemented before human
cases appear. Useful surveillance samples include fleas taken from rodent
hosts or their environment, tissue samples collected
--J: from rodents or other
animals suspected to have died of plague, and -serum
samples taken from
rodents or other animais, especially carnivores,
~.
The
types of samples
collected should be determined by f
the size of the area to be examined and
the goals of the project. Carnivore r--"
2 sero-surveillance is especially useful
when extensive geographical
rrc: must
areas
be
.
--surveyed, but follow up rodent and
flea surveillance and should be performed
in those areas where seropositive
carnivores were identified, to determine actual J __
rodent species involve in
local epizootics and the extent of these epizootics
Other recommended prevention
prevention and control
measures include public
education, avoidance of sick or
or dead animals avoidance of areas where
epizootics or epidemics have occurred
i
occurred. t
such as insect repellents or insecSc^e
P
protective measures
.
treated
clouhing,
treatment of pets
with insecticides to reduce thec risks
risks that these animals will carry
infectious fleas into homes, modifying environments near homes or other
areas to reduce amount of food and shelter available to rodencs, and
treating rodents or their burrows,
nests, or runways with insecticides to
reduce risks of flea-borne transmission,
employed, but these agents should i_ ’ Rodenticides are also occasionally
nor
control campaign has been initiated
” be applied until an aggressive flea
Killing rodent hosts without first
eliminating their fleas is likely to increase
human risks as the fleas
attempt to find new hosts to replace --------those killed by rodenticides. A
formalin-inactivated vaccine is also available, but its efficacy has
not
been demonstrated in clinical
trials. Indirect evidence suggests that it
is effective for reducing risks
o flea-borne plague, but the occurrence of
cases of pneumonic plague ramong
—
vaccinated ppersons suggests that the vaccine
might not be effective for- ppreventing plagueJ cases resulting from air-borne
transmission. Vaccination is recommended only for
persons, such as research
laboratory workers, certain
mammalogists, or others., who are repeatedly
exposed to high risks of Y.pestis infection.
f
.1
- . jr \ <
-
t .
? :.
’
BEBPOsgIBILITY
'■
*
:■
;
)
'•
i
.
i-
WtZWIWJ A8TD DIoBCIRSIRQ OFriCKRS
■’
•’
’■
-J;
1
K. Imp
___
____ ^
f amy
.uthyunjayas
Faculty (Financial Management)
A.T. I . , Mysore.
a.nd
•S. SIDDAEAJE GOWDA,
Joint Controller (Retd),
State Accounts Department
Mysore.
iaxaxda Account,wj-
Every C
Government Servant shall
accounts are maintained
maintaYnX^ for
7^ ??aii ensure that proper
transactions.
He 3houfrtf°r all government
financial
accounts to the A C should
°Mld render accurate ,and proper
to tne A.G, “
^■th all
all the
the Finance
Finance RuLs^ bS- thorou^ly conversant
checks to ensure that his ■' He should conduct frequent
subordinates will.jnot commit
Jiny fraud, . rcisapproprlati™
--1 or irregnlariti es.
He
should not rely on his L
subordinates
and should not plead
that he was misled by his
is subordinates (Art, 3 of KFC).
1.
PaidnfcintoaffoJernSentetalf °f ffovernment
should be
amounts collected
^affury within 2 days since
treasury balance (Art^V??
k*Pt aHaZ -from
j
the
2.
Separate
accounts
be
maintained
governroent money and should
non-government money (Art.
3.
Government <dues
’
paid :in the fore of
cash,
bank drafts,, ppostal orders
andmoney orders
---_..d
be accepted (Art.
(Art. 4).
1
for
4) .
cheque,
should
£
4.
Cheques and drafts .'should be treated as cash and
entered in cash book,, like other cash transactions.
5.
A governaxsnt officer receiving money on behalf pf
government must give the payer a receipt in KFC form
No. 1, (Art. 6).
6.
deads ol offices should keep a complete account of
the receipt books that they have received (Art. 6) .
7 .
The money received should be brought to the cash
book immediately,
the receipt number being noted
therein (Art. 6).
8.
Any person paying money into government treasury
. will present with it challan in duplicate in KFC
Form No. 2.
When money is paid by a private party
into a treasury, the copies of the challan should be
initialled by the departmental' officer (Art. 8) .
9.
At places where the cash business of the treasuries
is conducted by the bank, cheques on local banks may
be accepted.
When cheque is received,
only
a
preliminary acknowledgement be issued and final
receipt be issued after the cheque is cleared
(Art.
9) .
10.
The stamps affixed to documents should promptly be
punched.
Otherwise it gives scope for fraud and
loss of revenue.
11 .
The drawing and disbursing officers are required to
write their cash books independently and not on the
basis of treasury schedule and send their monthly
accounts/returns to the controlling officers after
duly reconciling the departmental figures with that
of treasury and furnishing a certificate to that
effect.
Every departmental controlling officer
should obtain regular accounts and return from 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 control11
win,
authority have to reconcil e the
accounts
action to reoov
Wi th A•G•
ThC 1:100'3 "hould take prompt
,
er
tne
moneys due to government.
following
The
i33Ue
and receipt of the
return are
a bo ve
Prescribed for adoption.
Bate n
of despatch from
the
AG's Office.
20th of 2nd men th
following.
Date of return by the
department
-- - d
af ter
verification.
10th of 3rd month
following
Regarding the yearly
accounts ending on March.
Not later than rhe
end of June
certif?c»r«COn^r°llinfi
authority
should
send
certificate of reconciliation to
A.G,
for every
month
the 15th of the 3rd following l
month.
This certificate should
also be recorded in theo pay
bill
f
or
c
_
. ,for
each
month,
rpertaining
:
to
the
reconciliation of
-- 3rd previous month
--- _.i (Art. 32) .
12.
Rents
due from government
occupying
- government buildings should be servants
recovered
regularly
by deduction from the salary
bills
Of such
servant or
as establishment
per the
suet government
government servant
as
per
rates
and
charges intima.ted
■ --d by Executive Engineer (Art. 41) .
If
13.
a claim be relinquished the value of the
claim
shall not be
recorded
on
the
expenditure
side
as a
as
specific loss,
remissions
and
abandonroe
’
nt
of
c
1ain =
to revenue shall be reported to the A.G. in the'forro
of- an annual statement with
June of the next financial .1 reasons before the 1st
year (44-A of KFC).
14 .
Public
money
in the ’
departments shall be kept
custody
of
government
in strong treasure ches ts
keyrn?d?y f \OCks °f Afferent patterns.
All
gazetted eovernm^t should be in the custody of the
tb v
3ervant who is in charge of
cash.
PO-session
k
p
y
^
Of
the other lock should be in
the
the keys is for°fb 1 $f3?ier- Thi3 deposition of
purpose
Purpose
of ensuring
that 'th- che-*
“
both
h
d
never
be
or closed
opened
withou t are L ?e ^ustodlans being present.
When
J
present.
there
double locking arrangements
arrangements for
for the
V
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 tne
the outer keys of the chest with the cashier.
When the government servant in charge of cash is
on
tour or on leave, he should handover the keys of the
chest together with the contents to any other
responsible government servant, The duplicate keys
of cash chests of government offices should be
deposited in sealed packets in the
Government
Treasuries.with which the offices transact (Art. 12,
13) .
15.
Every office should maintain "Register to watch the
movement of Cash/Bi1Is/Cheques" and obtain
the
signature of concerned officials (Art. 345 of KFC).
Expenditure
In essence, every expenditure should be relevant to
the objectives of the organisation and it should not be
more than the occasion demands
1. To incur any item of expenditure, there should be
competent sanction and budget allotment.
The
government servant must satisfy the cannons of
financial propriety.
(i)
Every government servant should exercise the same
vigilance in respect of government expenditure as
a man of ordinary prudence would exercise in
respect of his own money;
(ii)
No authority competent to sanction , expenditure
shall pass an order which will be to his own
advantage directly or indirectly;
(ill)
The expenditure should not be in favour
particular person or section of community;
of
a
(iv)
Expenditure such as T.A., etc., should not
source of profit to the recepient;
be
a
I
(V)
The
sanctioning
should
not
expenditure w ich atauthority
incur
a
later
date
may
proved
beyond his
to be
Power of sanction; and
(Vi)
Best
Possible results should be
public
from
funds keeping in view both obtained
economy and
efficiency (Art.
15 and 16 of KFC).
2.
highl^ 1 r2_PQyra7nt' arc opposed tv «11
to all rules and
Offices
and ohiectionable.
are
.over^jB -d^rat^r^t the6
government servants should be discharged
dela10
—
7-r possible delay.
In any case claims
----one year from the date when
it becomes
due.
-If- it1 has
to be paid after one
year, condonation of'delay
y is necessary (Art. 20).
^\h:
3.
Before, c2^d°ning the delay j _
'•
regarding the arrears of
payment, the Head
--- 1 exercise
the
following checks? of Department should
(a)
(b)
Claims
should be
Accounts Officer.
Verificatlo n
records.
got
should
scrutinised
be
done
with
by
Chief
original
(c)
The claim should be established beyond
doubt.
(d)
It should not result in
wrong or double payment.
(e)
Suitable register to be maintained
to watch such
sanctions (Art. 20) .
4,
Regarding r“yr..
payment of arrear claims, to avoid double
clalms/payment s the
make a
note
of the payment, drawing officer shall
• in acquittance rolls,
service
registors. oiilce copies of original bills,
etc.,.
5.
case
made °out
of Permanent
advances, the
UL
the amourt^shouId
recouped
at 0'!!
and
earl?thtr cases
Ca3e= ,' ■'
the liability 27*disllfrged
di scharged
the
Possible time.’
year /lhn°thiuir
ClalrDS Preferred within one
re 1 a ted
can
be settled by
without higher
be settles
>
> O£
5
I
for
saneti on.
Contingent bills not preferred
recoupment within 3 years should, as a rule not be
sanctioned or permitted to be encashed (Art. 21) .
6.
The right of a government servant to travelling
allowance
(tour T.A., transfer T.A. and conveyance
is
allowance claims) including daily allowance,
forfeited or de'smed to have been relinguished if the
claim for it is not preferred to the head of the
office or the controlling officer or the A.G. as the
case may be, within one year from the date on . which
it becom-es 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 head
(Art.
of the office continue to be held responsible
24) .
9. The head of the office shall ensure that the payment
is made to actual payee only and he should obtain
-clear acknowledgement (Art. 24).
for
government servant supplied with funds
10. A
funds
expenditure shall be responsible for such
until an account of them has been rendered to the
In cases in which
satisfaction of the audit office,
acquittances
of
the
actual
payees
are not sent
the
audit,
the
government
servant
supplied
wibh
for
shall
be
held
personally
responsible
for
funds
that
the
payments
are
made
•
to
the
person
seeing
He ---shall obtain for every
entitled to receive them, l._
disbursement which he makes on behalf'Of government
including every repayment of moneys which have been
deposited with the government a vodcher 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
an
separate
paper
to
be attached
to
it,
payment
signed
by
the
payee
by
acknowlederoent of the
.
.
^>.0
Q r
_ .1, to
-j ~
Rs. , r-500
hand and ink.
For the amount equal
should be
exceeding Rs. 500 stamped acknowledgement
i------- In exceptional cases, if it is impossible
obtained.
obtain
proper vouchers, the disbursing officer
to
record
the certificate saying that charges are
may
6
' I
i.,v.
reasonable •and actually paid.
When an article i s
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
disburaing officer.
officer.
Without this order,
Without
payment
should not be effected (Art. 49, 50).
1 1 . The Head of the Office is personally responsible for
all moneys drawn as pay, leave salary,
allowance,
etc. ,
m
in an es-uaoiisnroent
es.tablishroent bill signed by him or on
his behaif until he has paid them to the person who
are entitled to receive them and has obtained their
dated
acknO'Wledgeroents,
duly
stamped
where
necessary.
These acknowledgements shall be taken as
a rule on the office copy of the bill,
Separate
acquittances may be maintained for staff and for
private persona.
persons* The copies of the bills sent to
treasury to be maintained in the form of register
(Art. 52).
12 .
Undisbursed amount may be retained in office for a
period not exceeding 3 months.
A 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 cannot subsequently be
used fraudulently to claim or support a further
payment (Art. 58).
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 maintained in each office in KFC Form No.
11 for recording the objections communicated by the
Aud-it Office (Art. 60).
15.
Every government servant who draw bills for pay and
allowances on contingent expenses is
primarily
responsible for the correctness of the amount for
which each bill is drawn,
If any amount is drawn in
excess of what is due, the drawing officer will be
required to make good the excess amount is drawn
(Art. 62).
16 .
Each head of an office will maintain a register in
KFC Form No.
No . 12 for all special advances drawn by
him .
It is the duty of every government servant to
see to the prompt adjustment of advances and i terns
(C
i
^4
6^
■
in the books
under objection outstanding against him
--in
or the audit otflce.
It. o.lns to delay In
become
with the matter, any amounts become u
they
will be recovered prorata from
from
ained
government servants during whose uime,
Y
under objection (Art. 63).
17. The requisitions of the audit department *or supply
of information, necessary for purposes of audit
should be complied with by all departments promptly
(Art. 65) .
officers
disbursing
books * required by
Id. Cheque
Forest
j
like
PHD
&
authorised to draw on treasuries
from
obtained
by
them
Departments,
etc., should be <-the
requisition
signed
by
the treasury officer on a 1 .
. be
Cheque
book
must
disbursing officer himself,
personal custody of
kept under lock and key in the
i
charge
officer and
and when
when ttransfer
the drawing officer
'ranjX^r.r> of c„ cash
takes place, a note should be recorde
,
and
book,
over the signature of
both
the
c- unused
the relieving officers showing the num er o
made over
cheques and cheque books Mae
ovex an -----•
them.
No cheque
be issued f right
transfer by
by them.
No
cheque shall
shall be
3Um less than
Rs. 10.
On
cheques, right
than Rs.
10.
On the
the
cheque
angles,
the word to be written under
an amount a little larger than the amount
™
cheque.
All cheques/drafts
cheques/drafts on
on banks for amounts
exceeding Rs. 1,000
1,000 in
case.^other than p y
in each
each case
of government
allowances,premium,
premium-,
-- - -of salary, allowances,
etc.,.
should
invariably be
with the
servants
should invariably
be crossed,
crossed,
If
Qijdit^on of the words "Account
"Account Payee
Payee
x
'
the
cheque drawn is lost, before handing it over
stop order to
party, the non-payment certificate '.and
---- .
Afterwards
be obtained from bank/and or
=
request for
2_
If
fresh cheque may -be drawn.
It aa party,
"? request
to
the
pretext
that
the
fresh cheque on
c e
him is lost, the non-payment certifi
treasury,
order to be obtained from bank
bank/and
and i^denmity bond
Further, the party has_to
Afterwards fresh cheque may be
in KFC Form ho. 73. x--drawn (Art. 66, 72)
--- 1 an account with a
may open
19. Mo government servants
the deposit of moneys by him in his
private bank for '-- --official capacity' (Art. 76).
of temporary' posts
20.
'Hhere action for the continuance
stand sanctioned
the period upto which may authority has not
beyond
has been taken but the competent
such temporary
sanction,
the holders o
accorded
eiO •wy.-rr”
7-^0
posts
draw
from the A.G. Provisionally, without any authority
their pay and allowances at the same
rate as they were drawing in that post for a period
of
3
r
■
months
after the expiry of the period upto
which the
--J posts had been sanctioned (Art. 80(A).)
21 . Pay,
< -ficiatir^
-pay,
leave salary
other
pay ,
salary and
and
emoluments
--J ccan be drawn for the day of1 a government
servant's death,
does not* affect the hour at which death takes place
claim.
In case of death
of
government servant, the office head can make payment
to the claimant
--- J. upto Rs. C5,000 without
' '
insisting for
legal author]ty,
---------5,000,
IfC 1it exceeds
Rs.
office
head has to obtain an indemnity bond in KFC Form No.
13 duly stamped
« '
with sureties and also he has to
obtain the orders
--- j <of Head of Department.
In case of
death of gazetted officers necessary authorisation
should be obtained from A.G. (Art. 81).
22 .
Office heads are responsible for the deduction
income tax at the prescribed rates in respect
non- gazetted staff (Art. 89) .
23.
It is the duty of the office head receiving
receiving the
court attachment order to see that the amount
attached is deducted from the pay bill and also that
a record
rec<?‘lc^ is kept of such deduction in KFC Form No.
Ofrice heads should not enter into any kind of
correspondence with the court and they should not
forward
the representation of government- servants
(Art. 90 to 93).
” “ ----
of
of
(a) . Recoveries are to be effected out of the salary
payable
.— -lie and sent to Court or Society as the
case may be;
(b). In respect of Court attachment, it has to
shown
-1 as a deduction in the Fay Bill,
respect of Society dues it may be disbursed
cash;
(c) .
be
In
in
The
Officer
should
not
into
enter
correspondence
with the Court or
forward
representations .
He has to simply execute
provided the money is available;
i oSs
(d) . If the Government Servant does not sign °t
allows it to be undisbursed, in such cases the
Head of the Office in case of Hon-Gazetted
I-- ----Officers and the Head of the Depar ~ment in
respect of Gazetted Officers, may draw the pay
and pay the warrant amount;
(e) . The*following are the limits for attacnment
}?c.y:
of
(1) Salary to the extent of first four hundred
two-thirds of the remainder is
rupees and
i
the
not Liable for attachment towards
than
a
other
execution of pay decree,
decree for maintenance.
Allowances,
of
Travelling
(11) All
kinds
Conveyance Allowances, Uniform and Ration
Allowances,
House
Rent
Allowances,
Reimbursement of Medical Allowances and
provide
relief
granted to
Allowances
of
living
are
increased
cost
against
exempted from attachment.
house rent,
24 . Out of subsistence allowance, taxes,
If
loans and advances are compulsory deductions.
requests,
government servant who under suspension,
Insurance premium, dues of cooperative—societies^..
The GPF
recovery of GPF advance may be deducted.
court attachments and recovery of
subscriptions,
should
not
be made. The rate of recovery out
loss
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 disci, i.rge statutory duties and th'e handing over
of cash or stores is 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 or on transfer or
be
without fail
returning
from leave should,
the
same
day
to
the
A.G.
in
Form
reported by post on
No. 19. Every government servant who is responsible
adjustment of advances and
who
ia
for
the
to
another
office
before
•
fully
transf erred
accounting for the amounts outstanding against him
should leave for the information and guidance Qt hlsuccessor, a memorandum clearly explaining the state
of accounts of each item of advance and noting the
action tobe taken for adjusting the outstanding
amount.s within the time allowed by the sanctioning
au tho.ri ty.
If he does not do so, his responsibility
will not cease and his successor may not be held
responsible in respect of the items not brought to
the latter's notice.
A statement of unadjusted
advances and unremedied objections should be given
by the relieved to the relieving government servant
i.n KFC Form No. 20 & 21 respectively (Art. 100) .
27.
The entire salary for the month in which a transfer
has been made shall be drawn on the bill of the
establishment to which the government servant is
transferred, after the close of the month, attaching
these to the requisite LPC and not in several bills.
In respect of government servants transferred to
local
funds
the joining time"
allowance
and
travelling allowance for the forward and return
Journey shall be borne by local body concerned (Art.
129) .
28 . Arrear pay shall be drawn on a separate pay bill and
not in the original monthly pay bill.
The nondrawal certificate on the previous occasion shall be
recorded.
Only one bill is sufficient for all
arrear claims of different months which are drawn at
they same timeparticul*-3 01 ciaiwo of different
months, being however,
shows-- separately in the
bill.
All supplemental claims should be noted in
the original acquittance rolls. This is necessary to
Liie risk of claiming again.
A 'Due and Drawn
Statement'
in respect of arrears of pay
and
allowances of a government servant'shall be prepared
by the drawing and disbursing’officers (Art. 132).
29. Travelling allowance of establishment other than
permanent or fixed allowances, shall be drawn in KFC
Form No.
29 settingforth the details
of
the
journeys and explaining any divergence from the
recognised route; ordinarily not more than one bill
will have to be preferred for the claims of a
particular month in respect of a government servant.
The government servant countersigning travelling
allowance bills will maintain a register in KFC Form
No.
he
30 in which he will note the bills
countersigns (Art. 137).
30. Separate stock accounts or inventories should be
stores,
maintained for raw materials and consumable
in KFC Form No. 33 & 34 showing the receipts. issues
In the case of office furniture and
and balances.
other office stores, a Day Book in KFC Form No. 34-A
and a sample ledger account in KFC Form No. 34 for
each kind *of article are sufficient.
Once in a
For
quarter,
these registers should be verified,
separate register to be
books and periodicals,
When stores rendered
maintained in KFC Form No. 36.
obsolete, surplus or unserviceable, a survey report
The
in KFC Form No. 34B to be recorded with causes.
same should be disposed by public auction, by
recording the sale account in KFC Form No. 34C.
Atlocst once in a year, in April, the dead of
the Office or one of his Gazetted Assistant should
35
verify the stock. A Certificate in KFC Form^No.
of
to be attached to the April pay bill of read
Office,
Such certificate is also required tor the
first pay bill of relieving government servant
during transfer of charge.
The power to write-off the irrecoverable value
of stores,
or public money lost by fraud or by
negligence of individuals or other cause, is_ vested
Copy of orders to write-off should
with government.
be communicated to A.G. (Art. 164 to 173).
31. The cash balance should be checked with figures
shown in the cash book everyday by the ministerial
The head of the office should
head_ of office.
verify the totaling of the cash book or have this
done by some’ responsible subordinates other than the
writer of the cash book, and initial it as correct.
At the end of each month, the head of the office
■should verify the cash balance in the cash book and
record a signed and dated certificate to that
effect.
Regarding the-remittances he should ensure
that amount has been actually credited to treasury
by comparing with the consolidated treasury receipt
be
and the certificate of verification should
recorded in the cash book.
to
contain
the
•■'o
challan
pertaining
acknowledgement of treasury or a bank for receipt of
.□one/ should be acted on by the government servant,
unless credit for the roonej' is first traced in the
tree, surj accounts.
- ~1]
Separate accounts and cash box to be maintained
for government money and non - government money.
The employment of peons to fetch or carry money
snould be discouraged.
When it is
.
absolutely
necessary peons of some length of service and proved
u ^o^thiness should only be selected and in all
cases ,
when the amount to be handled is large,
one
or more guards should be sent to accompany the
messenger.
Cheques of private individuals if accepted in
payment of government dues or in settlement of other
transactions should be treated as cash and entered
in the cash book.
If the cheques so received be
numerous,
they may initially be entered in
a
"Register of Cheques received and adjusted" in KFC
Form No. 76 and only the daily totals of receipts
and remittances entered in the cash book.
This
book,
register will also facilitate the watching of the
clearance of the cheques.
When any such cheque is
cheques.
dishonored by the bank on which it is drawn,
the
credit previously afforded in the account In respect
of the cheque should be reversed by showing the
amount in the cash book as a minus entry on the date
of receipt of intimation of dishonour beingf entered
against the original credit and initiated to the
concerned party also as soon as possible (Art. 329) .
32 . The controlling authority after the distribution of
voted igrants is responsible for the controlling of
expenditure
through
subordinate
drawing
and
disbursing officers.
The DDO's should enclose a
token in the form of KTC 65-A for each bill,
This
token should be in the personal custody of DDO's .
Every DDO is responsible for maintaining
-- ; a Register
of_Bills for encashment in Form No. KFC 62-A.
Every
DDO and in respect of, his own expenditure from
portions of the grant retained in his own
hands,
every
controlling
officers or
the
competent
authority must maintain a----separate
in Form
--- -- register
- ---------KFC
K*. C 82-B.
62-B. When all DDO's returns for a particular
month have been received and found to be in order,
the controlling officer must prepare a statement in
KFC Form No.
62-D.
In this
this,,
he should
also
incorporate figures from his own register in KFC
rorm No.
62-B.
The DDO's should reconcile the
accounts with treasury and then forward the monthly
returns
to the
controlling----authority
with
cerci.-ica to of reconciliation.
The
controlling
autnority should reconcile the accounts with A.G.
and also to prepare an account in
(Art. 346).
Form
KFC
62-E
33. A proper record of personal advances drawn and
repaid by non-gazetted government servants should be
kept in all offices in a register in the form
separate
mentioned
under Article 347 of KFC.
A
necessary
register for each kind of advance is not
but a separate sheet may be allotted in the register
(Art.
for each individual who has drawn any advance
347).
34. The head of office is responsible for any loss
sustained by government through fraud or negligence.
He has to take all precautionary steps regarding the
movement of cash/bills/cheques/stores,
etc.,
by
obtaining
adequate
security
from
government
ser.van ts/contractors/supplier.
Particularly
he
should be cautious regarding the genuineness of bank
with
the
guarantees,
its
period
vis-a-vis
fulfillment of terms and conditions by suppliers
and/or contractors.
He has to follow the procedure
laid down in the Articles from 353 to 359 of KFC.
As per Article 332, deficiency found in cash,
person
should
be made good at once by
the
responsible for it.
As per Article 338 when the
government servant in charge of cash goes on tour or
on leave should, handover the keys of cash chest with
government
responsible
contents
to any other
servant.
If loss takes place, the head of office should
A.G. ,* Secretary,
send preliminary report to HOD,
through proper channel, explaining the nature
F.D. ,
circumstances with extracts of
documents .
and
Subsequently, the office head shall conduct detailed
investigation and send final report to A.G., H. 0. D.
The detailed
and Secretary through proper channel.
amount
report should contain the nature of loss ,
citation
of
documents
involved, persons responsible,
and its extracts, modus operand!, recoveries made,
disciplinary
action/Judicial
action
taken • or
recommended,
defects in system,
steps taken to
prevention.
11 offices, a register of valuabale documents
35. In
sho’il'.' be maintained and the receipts and disposal
f.ierein under the initials of a responsible
not-;'’,
be
should
servant.
The documents
no ver.-' inc
preserved
e or
°r other receptacles Intended to
keep
valuables coming into possession of
the
government servants concerned (Art. 367).
To
it is the duty of every
Servant conclude
to observe complete integrity in Government
financial
.matters , and c^fisure
--that
best
results
are
obtained
. from --ne public funds spent by him
and
strictly
guard against
-- - any kind of wasteful expenditure.
should not only satisfy himself but also satisfy He
the
requirements of audit.
drdlofre .kins
Rcpioductixc and Child Health Services
♦
Dr. G.V. Nagaraj*
Fhe Past :
For over ^0 years Family Welfare Programme was known for its rigid,
target based approach in contraceptives. The performance was
measured by the reported numbers of the four contraceptive methodsSterilisatiom Intrauterine device. Oral pills and Condoms This was
widely criticised for being a coercive approach.
The 1994 Cairo International Conference on Population and
Development (ICPD) formulated a growing International consensus
that improving reproductive health and family planning is essential
to human welfare and development.
A growing body of evidence and the Cairo consensus
consensus suggest
Numerical method specific contraceptive
contraceptive target
target and
monetary incentives" for providers to be replaced by a broader
system of "programme performance goals" and measures
focussed on a range ot reproductive health services.
The World Bank report-1995 concludes that, the current
contraceptive "Target and Incentive" system gives a demographic
planning emphasis to family welfare programme (FWP) which .is
antithetical to the reproductive and child health (RCH) client centered
approach advocated in the GOI-ICPD country' statement for the Cairo
conference. In particular emphasis on numerical targets is a major
reason tor the lack of attention to the individual client needs and is
detrimental to the quality of services provided
2^
Pl''-* *
*---- - •?7"7 ~
i____ - -,,____ ....
MBBS. DPH (Cal). PGDHM. MD. Ml” PHA
i”;' ■: > Additional Director (F-W^MGH)? r - -
State F\V Bureau. Ananda Rao Circle.
Bangalore 0 560 009
Family Welfare Programme to Reproductive Child Health
-The paradigm shift :
To date the impact ol Family Planning Programme has been
measured in terms ol their contribution to increase contraceptive
prevalence and to decrease fertility. These indicators are inadequate
for measuring the impact of reproductive Health Programme and
therefoie, new indicators for monitoring reproductive health services
and Service Quality from the perspective ot the client are urgently
needed.
Over the past decade there has been a clearer articulation and
definition of reproductive health as a concept and some thinking on
the ways in which reproductive health problems should be addressed.
Against this background the main recommendations of the World
Bank report on the Indian Family Welfare Programme (FWP) is that
the programme is to be re-oriented expeditiously to a Reproductive
and Child Health approach (RCH). The main objective of which
would be to meet individual client health and family planning needs
and to provide high quality services.
The principle g oal ol a reproductive health programme is to ff
Reduce unwanted fertility " safely there' by responding to the
needs ot the individuals for "High quality health services" as well as
to the demographic objectives.
The report recommends that the targets be replaced by a broad set of
performance goals and greater emphasis on "male contraceptive
methods especially vasectomy and condoms and greater choice of
methods.
If
■>
Government gioals
' for
* family planning should be defined in
terms of unmet needs for information
and services. Demographic
fo°™ 0SnXt"0LbqeuZ“?ed in ,ami,V
provided iktk
7
-World Bank - 1995
JU
)
7
)
The trend of health
programme should change from a "Population
Control Approach"
o reducing number to an approach that is
"Gender Sensitive and_ Responsive" client based approach of
addressing
reproductive health needs of individuals, couples and
families.
1
♦
L?bidi^X^i^nWanted Child bearin’ a"d -hted
What is reproductive Health ?
The 1994 International Conference
on Population
and Development
at Cairo (ICPD) has indicated a consensus
definition
complete physical, mental and social well being and i as a "State of
absence of disease or infirmity in all matters relation not merely the
system and its function and processes"
8 to reproductive
means that
• People have ability to reproduce and regulate their fertilitv
• TheTutcome of Xancyl^Tl
Saft'y'
infant survival and well being and
ln terins of maternal and
pregnancy'and'of conXnXj^Xh^h0-!^)
suX7f rXXngMsTndXo76 'd't "
‘0
empowerment Thus it extends bevond th
WOmen status and
Planning to encompass ah Z" s TT"
7family
reproductive health needs during the various stagZf iifZcie'
74
c.
Reproductive health programme is concerned with a set of
*
*
*
Specific Health Problems
Identifiable cluster of client groups
Distrinctive goals and strategics
The programme enable clients:
*
To make informed choices
*
Receive screening
*
Counseling services
*
Education for responsible and healthy sexuality
*
Access services for prevention of unwanted pregnancy
*
Safe abortion
*
Maternity care and child survival
*
Prevention and management of reproductive morbidity.
Implementing reproductive health services means a change in the
existing culture of the programme from one that focuses on
achieving targets to one that aim at providing a range of quality
services.
-
Objective of RCH packages are :
1. Meet individual client health and family planning needs.
2. Provide high quality services.
3. Ensure greater service coverage
RCH Policy :
The fundamental policy change is that Instead of remaining
responsible for reducing rate of population growth, reproductive
health programme would become responsible for reducing burden bf
unplanned and unwanted child bearing and related morbidity and
mortality.
Further the basic assumption is that improvement in service quality
will result in client satisfaction and will over long term translate into
>
higher coHtracept^ prevalence and ult.matelv fert.hty regulation. Bv
)
achiev-’Fh/nh- f'3 T servlccs the programme will be able to
renradTr v,
Tr
f °n'y redUC'ng fert,iltg but als0 reduci"S
reproductive morbidity and mortality.
New Signals :
Shifting to reproductive health
approach implies changing the
implementation signals. :
• Client satisfaction becomes the primary programme
goal with
demographic i mpact a secondary though imponant concern.
• Broadening 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
While still encouraging smaller families help
Client meet their own health and F.P. needs.
—
Priority services :
Performance
measures
Management
approach
Attitude to
client
--- ...
Full range of family planning services
Quality
of
care,
satisfaction. coverage measures .
client
Decentralised, client-needs driven,
sensitive
gender
Listen, assess needs, inform
«
Accountability :
To the client and communit}' plus health
F.W. staff.
and
76
Reproductive Morbidity and Alortnlitv :
• 1/j of the total disease burden in the developing countrv of
Women 15-44 years of age is linked to health problems
related to pregnancy, child birth, abortion. HIV
and
Reproductive tract infections (RTI's).
• The heavy load of reproductive morbidity among Indian women is
an outcome of th ier :
1. Poverty
2. Powerlessness
3. Low social status
4. Malnutrition
5. Infection
6. High fertility
7. Lack of access to health care
• India s maternal mortality ratio, usually estimated at 400- 500
per 1,00.000 live birth is fifty times higher than that
in
the
developed countries.
• In India a small study has revealed that for every’ women who
dies, an estimated 16 others develop various risks.
• Chronic and debilitating conditions such as vaginal fistulas
and uterine prolapse cause terrible suffering.
»
'I
Child Survival And Safe Motherhood Programme To
Reproductive And Child Health Services
I
A
)
)
Implementation of a very important, massive and highly credible U1P
rreTZu« rOm T '0 1991 thr°USh0Ut the
nt de
sem S Z ,
'mprovement ol'
and ch,Id health
country is stil|P| e ° 'n'k- compared t0 developed countries, our
as mfX nZ t ZT a11
reSpeCt °f Sens,tive indicators such
as infant mortality rate and maternal mortality rate.
>
Looking at the perinaIa| morta|jtv which contributes .Q%
nfant mortality rate and also one mother dying out of 250
>
pregnancies n can be concluded that immunization alone is not
adequate and will not be able to bring down these death rates
services named "CHILD s'ZZTZZTeZotHERHOOD0"
was .mplemented with the World Bank assistance from April-1992 to
September-1996 in all the states.
The main objectives of CSSM programme are
*
*
Improvement in mother and child health
Lowering the infant deaths (0 to I year) child mortality
(I to 4 years) and maternal deaths.
The package of services under tfiis programme are :
C hiidren :
1. Essential new born care
2. Immunization (BCG, DPT. Polio and Measles)
-V Appropriate management of diarrhoea cases
4. Appropriate management of ARI
5. Vitamin 'A' prophylaxis
Mothers :
7X
1. Ante-natal care and identification of maternal
complications
2. Immunization (Against Tetanus)
3. Deliveries by trained personnel
4. Prevention and treatment of anaemia
5. Promotion of Institutional deliveries
6. Management of Emergency Obstetric Care
7. Birth spacing
Essential Reproductive Child Health Services :
During 1995-96, Mandya was identified as Target Free District and
the performance was measured by certain quality indicators. Based Ion
the experience, from April 1996 all the districts in Karnataka have
adopted Target Free Approach" and the earlier implementation of
isolated programmes concentrating on Family Welfare and Mother
and Child Health under National Family Welfare Programme will
now be implemented as Reproductive and Child Health Services
which is equivalent to :
*
*
*
*
*
Family Planning
and
Child Survival and Safe Motherhood’Programme
and
Treatment of Reproductive Tract Infections and
Sexually Transmitted Infections and prevention
ofAIDS
and
Client oriented Family Welfare Services
and
High quality services
The specific programmes under Reproductive and Child
Health services are
1. Prevention and management of unwanted pregnancies
•l
)
2. Maternal care
)
)
>
)
>
>
)
>
a) Ante-natal services
b) Natal services
c) Post-natal services
I
3. Child Survival
4. Treatment of Reproductive Tract Infections (RTI) and
Sexually Transmitted Infections (STI).
)
)
)
The implementation guidelines of these health interventions at
various levels are detailed in the annexure.
)
)
>
>
L
)
I
> -
KO
ESSEN IIAL REPRODUCTIVE AND CHILD HEALTH SERVICES
A I DIFEEREN F LEVELS OF THE HEALTH SERVICES SYSTEM
Health
Inten ention
2 Mjilcrnily care
Coininunitv Level
I Early registration of all
Pregnant Women
2. Awareness raising for importance of
Prenatal Services
appiopriatc care during pregnancy &
identification of danger signs
Subcenler Level
transport, referral and blood donation
4 Counseling education for breast feeding
nutrition, family planning, rest, exercise &
personal hygiene etc..
First referral Unit/District
Level
Hospital Level
No. I-4 and
Nos. I-10 and
Nos 1-12 and
5. Three antenatal contacts
I 1. Treatment of T.B.
IT Diagnosis and treatment
of RTIs/STIs.
12. Testing of syphilis for
high risk group and
14 Weaklv clinenics for
I ligh risk pregnancies
with women either at the
sub-ccntrc or at the
3. To mobilise community support for
Primary Health Centre
outreach village sites during
immunisation/MCl I
sessions
treatment where ncccssan
including for RTFs.
6. Early detection of high
risk factors
maternal
complications and prompt
5. Early detection and referral of high risk
referral
pregnancies
7. Referral of high risk
6. Observing five cleans or through Social
marketing of disposable deliver) kits. Delivery
women for institutional
deli ven
planning as to where? when and from whom?
X. I realmeni of malaria
(facilities including drugs to
be made available at
* The need for IEC support and establishment
of First Referral facilities
subcentres)
I
9. Treatment for TB and
folloup.
10. Preventive measure
5
against all communicable
I
disease
J
xi
i
Health
Intervention
Delivery Services
Community Vcvcl
I. Early Recognition of pregnancy and its
danger signals (rupture of membranes of more
than 12 hours duration, prolapse of the cord,
hemorrhage)
2. Conducting clean deliveries with delivery
kits by trained personnel.
3. Detection of complications referral for
hospital deliver)'.
4. Providing transport for referral
Subccntcr Level
Nos. 1-4 and
5. Supendsing home
deliver)'
6. Prophylaxis and
treatment for infection
(except sepsis)
Primary Health Centre
Level
* training oflaboraton
technicians, equipment and
reagents required
Nos. 1-7and
8. Modified partograph
9. Deliver)’ sendees
10. Repair of episiotomy
and perennial tears
V.Routine prophylaxis for
gonococci eye infection.
5. Referral of New born having difficulty in
respiration
Postpartum sendees
6, IManagement
'
of Neonatal hypothermia
! 1. Breast -feeding support.
2. Family Planning counseling
3. Nutrition counseling
4. Resuscitation for asphyxia of the newborn
^Management of neonatal hypothermia
Nos. 1-6 and
Nos. 1-8 and
7. Referral for
complications
9. Referral to FRUs for
complications after starting
an I.V. line and giving
initial does of antibiotics
and o\\ toe in when
indicated.
8. Giving inj. Ergomctrine
after delivery of placenta
First referral Unit/District
Hospital Level
Nos. 1-9 and
10. Treatment of severe
sepsis
11. Dclivciy of referred
cases
12. Treatment of high risk
cases
13.Sen ices for obstetrical
emergencies anesthesia,
cesarean section, blood
transfusion through close
relatives linkages with
blood banks and mobile
sendees.
Nos. 1-10 and
11. Management of referred
cases.
PHCs and LRUs would
require additional
equipment and training for
management of asphyxiated
82
3
Health
Intervention
Community Level
Subcenter Level
6. Early recognition of post parlum sepsis &
referral
Child survival
I Health education for breast feediae nutrition
immunization, utilisation of sen ices? 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
(ARI).etc..
3. Help during Immunization by ANM
-I. Help during Vitamin 'A' supplementation bv
ANM.
Primary Health Centre
Level
First referral Unit/District
Hospital Level
10 . Management of
asphyxiated new born
(equipment to be provided)
new borns and
hypothermia. These include
a resuscitation bag and
mask and radiant warmers
Nos. I-It) and
Nos 1-6 and
Nos. l-9and
Treatment of dehydration
and pneumonia and referral
of severe eases.
10. Managemem of referred
cases.
11. Handling of all
paediatric eases including
encephalopathy.
12. Identification of certain
FRU's to provide specialist
services and training
Nos 1-8 and
Nos. I -9 and
9. Treatment of RTh/STIs
10. Laboratory’ diagnosis
and treatment of RTls/STls
S. First aid for injuries etc..
9 Closing watching on the
development of child and
creating awareness of cheap
and nutritious food.
5. Detection of pneumonia and seeking, early
medical care by community and treatment by
ANM.
Management of RTls/STls
6_ Treatment of di.iirhoca cases and ARI
eases
I I EC. counseling for awareness and
prevention
2 Condom distribution
3 Creating awareness about rusage of\sanitary
pads by women of reproductive period
< Creating awareness of about RTFs and
Personal hygiene
No I and 4
? Identification and referral
for vaginal discharge, lower
abdominal pain, genital
ulcers in women, and
urethra discharge, genital
ulcers, swelling in scrotum
or groin in men.
Id. Syphilis testing in
.mtcnatal women
f
I I .Syndromic approach to
detect and treat STD in
Antenatal post-natal and al
risk groups
/
8^
!
Health
hitencntion
CoininiiiiiK I.ex cl
Sul) ecu I er Lexel
Primary Health Centre
Lexel
First referral L'nit/Disirict
Hospital Lexel
6. Diagnosis of RTI/s and
STI's by Syndrome
approach.
7. Referral of Cases not
responding io uscx al
treatment .
I.
8. Partner
notification/rcfcrral
h i ————
i '
i
■
I. ■
i ■
X4
4
i
I he Package of
Reproductive and Child Health Sen ices
Reprocuctive Child Health (RCH) can be delined as .1 stale in which "People
have the ability to reproduce and regulate their fcrtilm. women are able to uo'
through pregnancy and child birth salelv. the outcome of preenanev .s successful;
in tenn> of maternal and infant survival and well being, and couples are able m
iave sexua lelations free of the fear of pregnancy and contracting disease” This
means mat every couple should be able to have child w hen thev7want and that
he pregnancy is uneventful and see. that the safe delivery services are available
at at the end of the pregnancy the mother and the clu’d are safe and well and
contraceptives by choice are available to prevent pregnancy and of
contracting disease.
~
The essential elements of reproductive and child health services at the community
and sub-centre level are given below which will help you to understand how the
reproductive and child health services are to be provided at the communitv level
The different semces provided under RCH programme are ■
I. FOR THE MOTHERS :
TT Immunization
*
Prevention and treatment of anaemia
*
Antenatal care and early identification of maternal complications
*
Deliveries by trained personnel
*
Promotion of institutional deliveries
*
Management of Obstetric emergencies
*
Birth spacing
II. FOR THE CHILDREN
------------------ :-------*
Essentia] newborn care
*
Exclusive breast feeding and weamne
*
Immunization
*
Appropriate management of diarrhoea
*
Appropriate management of ARI
* Vitamin A prophylaxis * Treatment of Anaenua
HI. FOR ELIGIBLE COUPLES
’-----------------* Prevention of pregnancy * Safe aboilion
IV. RT1/STD
’
'
’-------------------Prevention and treatment of reproductive tract and sexuallytransmitted diseases
*
!i
X?
<v\ p r /
G
-
- Mrs. Javasliree’
Procurement and Distribution of Diet to the patients in Hospital has an important Role
The Diet, to the Patients are classified into several categories as follows :
1.
2.
3.
4.
Basic Diet - i.e . Rice, Curry
Convalencent Diet - i.e., Bread and Milk
For T.B. Patients
Diabetics
5. Children
6. Ganji and
7.
Milk
The Ratiois fixed in G.O. No.PLM 177 MRS 62 dated 27.2.1963 and as amended from time
to time.
Normal Diet starts with Morning Coffee at 8 A.M., Afternoon Lunch at 12 Noon, Evening
Coffee at 3 P.M. and Night Dinner at 8 P.M
As regards of Procurement, all the Rules and Regulations followed for Purchases L_.
by
Government, is to be followed for these Purchases also i.e.. calling for Tender, wherever
necessary and if Rate Contract is not taken up, Purchases to be made from Government
undenakings, Janatha Bazaar and Co-operatives.
The food grains like Rice,* Sugar, Wheat etc., are obtained from Public Distribution System
(i.e..- Govt. Fair Price Shops).
Vegetables to be procured through HOPCOMS wherever the facilities are available or
otherwise by calling tenders.
Milk to be procured through Milk Federations, if such federations are not availalbe by callinu
for tenders.
Bread is procured, 50% through Modern Breads, which is of Government of India
undertaking and 50% by calling quotations.
In additions calling for quotations before finalising tender. Market rates are to be assessed by
correspondence with Marketing Federation.
i he detailed Circular on Procedural aspect and also the quantum of ingredients to oe’used in
preparation of diet to each patient as issued in Government Circular of 1963 also tiiven to you
all, for your references.
B A.. Las- Secretary. Gosha Hospital
60
Yoga provides hundreds of methods to suit different mdividuals with differL
)
and bhs?'0
* UP a" lead,nS tO tHe Same gOal of devel°Ping the inner quietijde
V<,n“S P“,Ures- l"“h
and Sa J„a
rn/
1
ones own conflicts, suppressions and sensitivities Yoea makes a
iciently “
as 1,6
he learns the
background^S"™
“^"S and enjoy,ng .he work in the
mjier bliss.
SsiA Xn S afaX”” «cl,n,ql,'= ».^ke one on a progressive pa h. '
the form of relaxation pr™Xxl>eUP<!rfi'lil1 rem“ieS “ Ihe bo<l>' a'ld rnind level i"
.hrooghadapong.deeo^XSSX0
Several scientific papers from different ce^Kall
efficacy of yoga in the above mentioned ailments^> over the world have shown the
;eper investigations are on way.
It is the feeling of many researchers
in the medical profession today, that yoga can
become a holistic solution to the s
uffering man as drugs arebr wing more and more
useless in several ailments.
59
Proceedings of the Government of Mvsore
Sub :
Introduction of Diet Scales in terms of Metric Weights and Measures - sanctions.
Read : 1
2
Government Order No. LLM 78 MDS 97 dated 7.12.1960. Prescrib.ng the
quantitative scale of basic diets in the various hospitals (Allopathic) in the State
Gocrespondence ending with letter No.DLN/96/62-63 dated 28 11 1962 from the
Director of Medical Services.
Preamble :
introduction in the State and haXTuesX^^^^
fOr the
scales of Basic D^mM
°f Mefcal S^ices that the present proposals for fixing
hie-MarketOffi e Tr We‘?%and measures have been sent in consultation with th^
ms 'h' ““
sca.es
Order No. PLM 177 MHS 62 dated '27lh February 1963.
Tr-aT rT > Pf0P-0-Sf,S of the Direc.tor of Medical Services are approved. It is directed that the
and Measures^iniicate^ m the'annexure apTendld to'fhisTrder^
°f
WeightS
By order and in the name of the
Governor of Mysore.
Sd/H.K. Ananthasubba Rao,
U.S., to Govt., P H. Lab., Muncl., Dept
No.DLN/96/62-63
Directorate of Medical Services in Mysore
Bangalore, Dated : 29.4.1963.
re f™rded ,O
“•die,. Officers and De.es for
Sd/For Director.
61
Annexure to Government Order No.PLM 1/7 HRS 62 Dt. 27'1’ Febv. 1 963
Basic Diet or Rice and Curry Diet
R:ce
12oza. 340 g
Coffee
Dhal
Butter Milk
Pepper water
Plantain
Vegetables
Curry powder
Oil
Tamarind
Onion
Sail
Firewood
Bread
or Idly Sambar
Coconut
Mutton
or Fish
or Rules
or Egg. *
1 pin - ’/z Litre 7G
2 ’Z: oza=70 grams
’/S pint ='/4 litre=35
4 oza = 113 g.
8 oza = 227 g.
4 drams = 7g.
Vi oz =14 g
Vi oz = 14g
'/2 oz = 14g
Vi qz = 14 g
IK 10=794 g.
4 oz=l13g
2 Idlies=56g
2 Ozs
1 oz = 28g
3 oz = 85 g
3 oz = 85 g.
-3_oz^85g.
2 Nos.
Formulas for Preparation of
Butter Milk for
Soza of milk
One point
227 grams.
Coffee or Ten ’Z: (Coffee powder
pint
drasm = 7g.)
Milk
3 oza 85 g.
Jaggery or Sugar
1 oz = 28 g.
Pepper Water >
Pepper
2 drams = 3g.
Chillies
4 “
= 7g.
Garlic
2 “
= 3g.
Tamarind
8 “
= 15g.
Salt.
3
= 5g.
Idly 2 oz>
Rice
2 oz 10=45
Blackgram Dhal
Salt
Sambar 1 cup of
Dhal
Onions
Tamarind
Salt
Oil
4
g-
10 Drams = 17gl'/2 “
= 2‘/2g.
2 oz = 56 g.
4 oz = 7 g.
2
“ = 3 g.
I’/z “ =2,/2g.
l*/2 “ =2’/2g.
■/2
“ = 1 g.
Plantains :
Measuring not less than 4l/i in length and
weighting 6 to a pound.
Oik
Sweet oil or gingelly oil or vegetable fat
Eggs by weight :
I ‘/z to 2 oza =
Mutton without bone soup mutton with
bone.
Curry Powder in the Preparation of :
Coriander 50 lbs = 22Kg. 700 g.
Chillies
50 lbs = 22Kg. 700 g.
Pepper
I lbs
I Kg. 362 g.
Mustard
1 lbs
1 Kg. 362 g.
Cumminseed 6 lbs = 2 Kg. 724 y.
Vendium
2 lbs =
90S g.
Turmeric 3 lbs = 1 kg. 362 g.
62
C Pantey Aves
Instead of 12 oza of iles, wheat and dhal
cereals 6 oza 170 grams.
Rice
4 oza = I 13 g.
Bakery Bread = 40 oza = I 13 g.
2 Instead of Coffee, Tea
'A oz = 7 g.
« Soza for,curds or for drinking straight = 227y.
wj3’™^ Instead Of Bread Oza Id‘y and Sambar (2 idlies and 20 za of Sambar) be
i grams.
PePPers
2 or 2 or each = 56
Coffee or Tea = V2 pint. *4 liters = 33grams.
Children Diet
Ordinary
^ce
40 za - 113 grams
Two Idlies and 2 oza of Sambar or Bread
40 oza - 113 grms
Plantain one Buter Milk % pint 1/8 litre = 18 gms.
M'lk.. . . l!/2 pint
litre = 106 gms.
Firewood.. 1
Lbs. 794 gms.
Salt
I 2/3 drams = 2'/2
Tamarind..
2/3 drams = 1 gm.
Vegetables 3 oza = 85 grams.
Sugar 2 oza = : 56 gms.
3
Convalescent Milk and Bread Diet.
Bfead
12 oza = 340 gms
or Bread 8 oza and Idli Sambar = 227 gm.s
(2 idlies and 2 oza of Sambar)
Butter /2 oz = 14 gms.
Sugar 1 oz = 28 gms.
Plantains 2 oza = 56 gms.
Coffee or Tea 1 pint Vi litre = 70 grams.
Milk 1 V2 pint = 3/4 litre = 1-6 grams,
Firewood l3/4 Lbs. 794 gms.
4.
t
Ganges Diet
Milk 20 oza — 567 grams.
Sugar I1/: oza = 42 grams.
Ar, oroot or 4 oza 1 13 gms.
Orange or Sweet Lime 1
63
5.
Milk
Milk 48 oza — 1 kg. 362 gms.
Sugar: 2 oza = 56 gms.
Barley : I oza = 28 gms.
Tea or Coffee I pint / V2 litre = 70 gms.
Firewood 1 Lb = 454 gms.
Wheat and other Cereals
Bread
Pulse
Leaf Veg.
Root Veg.
Other Veg.
Fruits
Vegetable Oil
Butter
Milk
Fish or Mutton
Condiment.
Diabetic Diet Vegetarian
4 oza =113 gms.
2 oza = 56 gms.
3 oza = 85 gms.
8 oza = 227 gms.
2 oza = 55 gms.
2 oza = 56 gms.
3 oza 85 gms.
2 oza = 28 gms.
’/S oz = 14 gms.
16 oza = 454 grams
'/i oz
14 grains
Non Vegetarian
4 oza =113 gms.
2 oza = 56 gms.
2 oza = 56 gms.
8 oza = 227 gms.
2 oza = 56 gms.
2 oza = 56 gms.
3 oza = 85 gms.
1 oz = 28 gms.
Vi oz = 14 gms.
16 oza = 454 grams
3 oza = 85 gms.
I oza = 28 gms.
•)
64
Indian Diet
7
T.B. Diet:
(a) Morning 7 A.M
Coffee
Bread
4
’/z pints = Litre - 35 gm.
One
Meal at 1 1-30 A.M
Rice
Dhal
Vegetables
Curry Powder
Vanaspathi
Salt
Tamarind
Onions
Coconut
Curds
Mutton
14 o^.a. - 390 gms.
100 6 gms.
10 oza = 285 gms
6 dms. = 10 gms.
8 dms = 13 gms.
8 dms = 13 gms.
8 dms = 13 gms.
8 dms = 13 gms.
1 drm = I y2 gms.
'/z pint % litre = 35 gms
4 oza =113 gms.
’/z pintJ4 JiLre_= 3 5_gms
Meal at 6-30 so IIndian Diet without Mutton
and Milk l/2 pint — % 35 gms
High Protein Diet
Basic Diet / H.P.H. of Food Dechnology / One Egg = 1 Pint = '/2 Litre = 70 gms.
Mutton soup :
Soup Mutton with bone
Pepper
Salt
r
8 oza - 227 gms.
1 oza = 28 gms.
1 drams = 1 gms.
Sd/H.K. Ananthasubba Rao
Under Secretary to Government
Public Health Labour and Municipal Adm.,
Department.
65
Pioccedings of the Govern ment of Karnataka
Subject : Introduction of Diet Scales iin Metric \\ eights and measures
Read :
I. G O. No. LLH . 78 MDS 57 DT. 7.1 2 60
2 G O. NO. PLHM 177 MHS 62 DT 27.2.63
3. Correspondence ending with letter NO.AAR 18127/67-68 Dt 23 9 68 from the
Director of Health & F.P. Services, Bangalore.
Preamble :
In the Government order dated I 7.12.60 read at I above, sanction was accorded tj fix
up e quantitative scale of basic diet as per the an-.exure appended to the Government orderin respect of various Medical Institutions of the State
kin.
:s:
£s
■
r:
measures as was indicated in the annexure to the government order.
The Director of Health & Family Planning Services in his letter read at (3) above has
reported that due to certain typographical and other calculation errors some complications
ave been not.ced as observed in the audit for not expressing cenain articles in terms of Metric
Weights, particularly with regard to Milk and Plantains. In order to overcome to audit
objection m this behalf, the D.rector of Health and Family Planning Services has forwarded a
revised statement indicating the correct quantities in the metric Unit as agreed to by the
on ro er o
eights and Measures. Bangalore, for approval of Government thereto.
ORDER NO. HMA 261 PTD 68 BANGALORE, DATED THE 9th
DECEMBER 1968
JT pr°posal of the ^'rector of Health & F P Services, Bangalore are approved It is
directed that the scales for different kinds of diets in all the Hospitals'in the State be in terms
of Metric Unit m respect of cenain articles as indicated in the annexure appended to this
Order, superseding the terms approved in the previous government order
BY ORDER A.\D IN THE NAME OF THE
GOVERNOR OF MYSORE
Sd/I S. Shaikh.
Under Secretary to Government,
I IMA Depl .
t
->
66
/
Comparative Statement showing the quantitative of certain
Order C
LLH MDS S7 ni 7 , Z?'”."
i" »■« C.vernme.,,
LLH MOS 57. D(. 7.12.60 and (2> PLM 177 Mils 62. Do 27.2.63 and U.e rorrecl quandiy <„ l,c
fixed in (he Metric System.
ANNEXURE TO GOVERNMENT ORDER NO
SI.
No.
1
2
3
Name of the articles
Under
Powder
Mustard
C.M.D. Diet
Plantains
Bombay Area
Hoppers
Qty. indicated in
G.O. dated 7.12.60
Qty. indicated in
G.O. dated 27.2.63
Correct Qty. to be
fixed in the Metric
System
Recommended Qty.
in Metric Units by
the Controller of
Weights and
Measures,
Bangalore)
3 lbs.
1 lbs
3 Lbs
1.360 Kgs
uri
2
2
2
2
2
6
1 Kg. &
Remarks
162 gms.
2
2 ozs - 56 gms?
2(8 ozs) - 227 gms
230 gms
2 off 2 ozs c.ach
2 of 2 ozs each :
2 of 2 ozs each
55 gms
r I
T.B. Piel
Curry Powder
Vanaspathi
Salt ________
Tamarind
Onions_____
Coconut
HMA 26 PTD 68 , DATED THE 9th DECEMBER 1968.
.6 drams
8 drams
8 drams
8 drams
8 drams
1 dram
10 gms
13 gms
13 gms
13 gms
13 gms
1 1 gms
fems
lO1^ gms
14 gms
14 gms
14 gms
14 gms
28 gms
56
10 gms
1 5 gms
15 gms
15 gms
15 gms
28 gms
b
j
67
-d
Rice & Curry Diet
'/2 Pint butter milk
4 oz (Milk)
35 gms
0.113 Litres (Milk)
Milk)
Children Diet
I
2
Milk (I y2 pin)
Butter Milk (l/2 pint)
Milk A Bread
Milk
Conji Diet
Milk_______
Milk Diet
Milk________
Diabetic Diet
Milk
30 oz
2 Oz (Milk)
NOTE . 1 Pint
3/4 litres of
0.406 gms
0.852 litres
840 or 850 ml
0.018 gms
0.055 litres (Milk)
(Butter Milk)
142 or 150 ml
50 ml . Milk.
—
30 oz
20 oz
48 oz
16 oz
Coffee
'/2 Pint coflee
284 or 270 ml 100
ml.
Milk
(Butter
3 oz (milk)
3/4 litres of
0.106 gms
0.852 litres
840 or 850 ml
Jjms
0.568 litres
560 or 550 ml
I 362 gms
1.362 gms
1344 or 1350 ml
0.454 gms.
0.454 litres
448 or 450 ml
0.085 litres (milk)
Coffee 284 or 270
ml = 80 ml. Milk
0.085 gms.
r
20 fl/oz. 0 568 ml
• i
Sd/l.S. Shaikh
Under Secretary to GpvrJH M.A. Department.
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