JAWAHARLAL INSTITUTE OF POST-GRADUATE MEDICAL EDUCATION AND RESEARCH PONDICHERRY
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JAWAHARLAL INSTITUTE
OF.
POST-GRADUATE MEDICAL EDUCATION
AND RESEARCH
PONDICHERRY
COMMUNITY HEALTH SERVICES
AND TRAINING
DEPARTMENT OF PREVENTIVE
AND SOCIAL MEDICINE
1991
in-'"Munity health cell
JAWAHARLAL INSTITUTE
OF
POST-GRADUATE MEDICAL EDUCATION
AND RESEARCH
PONDICHERRY
With-
best
compliments from
PROFESSOR & HEAD
PARTMENT OF PREVENTIVE AND SOCIAL MEDICINE
JIPMER, PONDICHERRY - 605 006
INDIA.
COMMUNITY HEALTH SERVICES
AND TRAINING
DEPARTMENT OF PREVENTIVE
AND SOCIAL MEDICINE
1991
CONTENTS
Foreword .......................................................................... i
Introduction
..................................................................... 1
Field Practice Areas
....................................................... 3
Community Health Services
Rural Health Centre....................................................... 4
Urban Health Centre....................................................... 4
Some Highlights of the service ....................................... 6
Rural Health Services Mobile Clinic .............................. 12
Community Health Training
Medical Undergraduates
............................................... 17
Medical Interns .............................................................20
Medical Postgraduates
.................................................. 21
Other Health Personnel .................................................. 21
Integrated Teaching....................................................... 22
Students Assignments
.................................................. 22
Participation in Other Community Oriented Health Programmes
Universal Immunisation Programme...............................23
Integrated Child Development Services
......................... 26
National Leprosy Eradication Programme ...................... 26
National Goitre Control Programme .............................. 26
Conclusion........................................................................ 27
1
FOREWORD
We are happy to bring out the third edition of the
booklet describing the community health services and
training.
JIPMER Rural Health Centre has completed twenty
five years of service and has been the main basis for
community oriented training.
It is hoped that this booklet would be informative and
useful to those concerned with education and training.
Head of the Department and Staff
of Preventive and Social Medicine
1
INTRODUCTION
Proper organisation, efficient management and
effective delivery of health care services depend to a great
extent on the type and nature of teaching/training and
orientation that are provided to different categories of
medical and health personnnel. The quality of the services
provided is also greatly linked to the capacity with which
all the members of the health team are able to perform in
unison and also co-ordinate their tasks/activities to achieve
the maximum benefits for the community they serve.
The National Health Policy (1983) has emphasised the
need to criticallyreviewthe processandapproach to the
professional education of medical and health personnel at
all levels in terms of the national necds/demands and
priorities. This certainly calls for suitable restructuring of
the curriculum and training programmes so that the health
manpower developed in future in our country possesses the
requisite skills and competence required of them.
With these points in view Jawaharlal Institute of Post
graduate Medical Education & Research (JIPMER),
Pondicherry has framed the institutional objectives for the
teaching of medical undergraduates. Those objectives
pertaining to Community Medicine are as follows. The
medical graduate shall be
1)
Aware of the social, economic, cultural, environ
mental and psychological aspects related to health
and disease.
2) Able to apply clinical skills to elicit detailed his
tory, perform relevant investigations, recognise and
manage common ailments
4)
5)
6)
7)
Able to define and make diagnoses of the health ?)
problems of the community and manage them by
a) organising elementary epidemioligeal studies of
health problems of the area
b) formulating a plan of action to manage the most
important problems according to national
priorities particularly the national health, family
welfare and disease control programmes.
c) organising health care services in areas affected
by natural disasters and calamities.
d) appreciating the team concept and working as an
effective member of the health team and
e) evaluating the different health care activities and
programmes that are in operation.
Able to plan and implement effectively health
education activities.
Able to perform effectively the administrative func
tions that would be required of his/her job position.
Competent in dealing with medical emergencies
and providing first aid to save life or limb and
Able to appreciate the need and importance of self
learning and make constant efforts to acquire new
knowledge through this method and also by attend
ing regularly continuing education programes.
This booklet describes the on-going programmes
for community oriented training of medical and other health
personnel and the community health services provided by
the institute.
3
FIELD
PRACTICE
AREAS
Two health centres, one in the rural and the other in
semi- urban area,were established as extension units of
Jawaharlal Institute of Post-Graduate Medical Education
and Research (JIPMER) in 1959 and 1961 respectively.
The staff working in these centres are under the
administrative control of the Director, JIPMER and are
supervised by the Department of Preventive & Social
Medicine.
The three principal activities of the centres are:
1. Teaching/Training
These centres provide teaching and training in
community medicine to undergraduate and postgraduate
courses like MBBS, B.Sc.(MLT) and M.D. (Community
Medicine), medical officers and other categories of medical
and health personnel.
II. Service
They provide comprehensive health care services to
the community
III. Research
Applied research on various community health
problems and different aspects of health care delivery is
conducted in these centres.
The activities related to provision of health care by
the Health Centres are first described.
Fig.l Map showing the six Primary Health Centres
(PHC) catered under the Reorientation of Medical
Education Scheme
4
COMMUNTIY
HEALTH
SERVICES
JAWAHARLAL INSTITUTE RURAL HEALTH CENTRE
The Rural Health Centre was initially established in
Kandamangalam village of South Arcot District of Tamil
Nadu in 1961. In 1966 this centre was shifted to
Ramanathapuram village in the Villianur Coimmune of
Pondicherry with the idea of locating this centre within the
Pondicherry region.
This centre provides family centred comprehensive
health services to twelve villages of the Union Territory of
Pondicherry. It caters to a total populationof 16,614 or 3063
families (1990). This health centre is situated about 12 kms
away from JIPMER. There are two subsidiary health centres
in the area- one at Coodapakkam and another at Sedarapet.
The area covered by Rural Health Centre, Ramanathapuram
is shown in Fig.l.
Participation of Other Teaching Departments of the
Institute
Keeping in view the national need for providing rural
oriented training to medical undergraduates and interns the
teaching faculty from the departments of Obstetrics &
Gynecology, Dermatology and Ophthalmology periodically
visit this centre for providing consultation to referred cases.
Their visits also provide an opportunity to the interns posted
there to pick up further clinical skills and management
techniques related to these disciplines. Thus an attempt is
also made to bring the specialists’ services as close to the
rural community as possible.
JAWAHARLAL INSTITUTE URBAN HEALTH CENTRE
The Urban Health Centre was established in May 1959
to serve a population of 2300 of Kurichikuppam, a
Fig. 2 Map showing the Urban Health Centre Area
5
semi-urban area of Pondicherry. The service area of this
centre was subsequently extended in 1964 and 1983.
Presently, the centre provides family centred
comprehensive health care to a population of 8543, i.e. 1766
families (1990) living in Kurichikuppam, Vazhakulam and
a part of Vaithikuppam. The area covered by this centre is
shown in fig. 2.
Staff of the Health Centres
The staff provided by JIPMER and the Directorate of
Health & Family Welfare Services, Government of
Pondicherry in both the centres is shown below.
Number of Staff
Category of staff
Urban
Health
Centre
1
Medical Officer
2
Public Health Nurse
1
Medico-Social Worker
Sanitary Inspector
1*
Health Assistant (malaria)
2
Auxiliary Nurse Midwife
2
Pharmacist
1
Lower Division Clerk
1
Driver
5**
Other ancillary staff
* Staff of Government of Pondicherry
** Two staff belong to Municipality of Pondicherry
Rural
Health
Centre
2
3
1
1
2
2
1
1
9
6
Family Folders
The major focus of the health centres is around family
as a unit to receive total health care. To achieve this
objective a ‘Family Folder’ is maintained for each family
in these centres. The status of health, episodes of illnesses
and all services rendered to the family both in the centre and
in the home are carefully documented in the indivudal
health cards maintained for each member of the family in
those folders.
SOME HIGHLIGHTS OF THE SERVICES PROVIDED
Medical Relief
Out-patient services are provided daily in the
forenoon. The average daily out-patient attendance is 130
and 110 at Rural and Urban Health Centres respectively.
The ten leading causes of morbidity observed in each
of these centres during 1990 were :
Percentage of total morbidity
Causes of morbidity
Urban
Health
Centre
Rural
Health
Centre
1. Respiratory Diseases
2. Injuries
3. Skin Diseases
4. Fevers (including Malaria)
5. Diarrhoeas
6. Gastro-intestinal diseases
7. Nutritional Deficiencies
(including Anaemia)
30.3
13.0
10.7
6.0
4.8
4.7
3.7
28.1
7.6
9.4
6.4
8. Ear-Nose-Throat diseases
9. Helminthiasis
lO.Eye Diseases
11 .Dental Diseases
2.9
2.6
1.5
10.1
-
4.7
2.4
4.5
2.8
1.8
7
Special Clinics
In both the health centres special clinics arc held once
a week to provide (a) special services for antenatal mothers
and under five children and (b) follow-up care for leprosy
and tuberculosis patients and (c) mental health clinic at
Urban Health Centre only. Eye clinic is held once a month
at the Rural Health Centre.
Indoor Facilities
Rural Health Centre has six beds - four for maternity
cases and two for other cases. Patients needing specialists’
services are referred to either the JIPMER Hospital,or
General Hospital, Pondicherry.
There are, however, no indoor beds in the Urban Health
Centre since this centre is very close to the Government
General Hospital and the Government Maternity Hospital,
Pondicherry.
Maternal And Child Health
Institutional as well as domiciliary services are
provided by the two centres for maternal and child health
care. Facilities for delivery is available in the Rural Health
Centre round the clock.
Some of the important features of this service are :
* Registration of all expectant mothers in the area.
* More than 80 percent of antenatal mothers have at
least three contacts with the health personnel.
* All antenatal mothers are provided tetanus toxoid
immunisation
* Centre midwives are available round the clock for
attending to home delveries
* Periodically training is organised for the tradi
tional birth attendants of the health centre areas
8
No case of neonatal tetanus has occured in the
areas since 1967.
* Infants are provided immunisation against the six
vaccine preventable diseases of childhood viz.
tuberculosis, diphtheria, pertussis, tetanus,
poliomyelitis and measles.
The immunisation coverage for different vaccines
among infants and antenatal mothers during 1990 is shown
below.
Percentage of vaccinated
Urban
Rural
Vaccine
Health
Health
Centre
Centre
*
Infants
BCG
DPT
Oral Polio
Measles
Antenatal Mothers
Tetanus Toxoid
100.0
96.0
96.0
100.0
95.1
96.0
96.0
96.1
100
100
Family Welfare
Family welfare activities are being carried out as part
of maternal and child health care programme in both the
centres.
Facilities for insertion of intra uterine devices and
vasectomy operation are available at these centres.
Conventional contraceptives and oral contraceptive
pills are also distributed.
9
Cases motivated for tubectomy are referrred to either
the JIPMER or the Government Maternity Hospital,
Pondicherry.
Eligible couple registers are also maintained
up-to-date.
The couple protection rate for rural and urban health
centres for 1990 was 50.8 and 53 percent respectively.
School Health
Under the school health programme the Rural Health
Centre and Urban Health Centre have been allocated four
schools each. The student strength of the schools allotted to
rural and urban health centres is 1400 and 1187
respectively.
The health check up of these children is carried out
annually. Children found suffering from any illness, disease
or defect are provided appropriate treatment.About sixty
per cent of the children examined in 1990 had some illness
or defect.
Since October 1990 a control programme for
Rheumatic Fever and Rheumatic Heart Disease among
school children has been started in the Rural Health Centre
area. This programme is to be extended soon to Urban
Health Centre area also.
The objectives of this programme are :
i) To detect ‘strep throat’eases and institute primary
pro- phylaxis for the needy children and
ii) To identify cases of Rheumatic Fever/Rheumatic
Heart Disease for providing secondary prophylaxis
for such cases identified.
Control Of Chronic Communicable Diseases
Case detection, provision of domiciliary treatment,
contact examination and health education are the important
10
elements in the national tuberculosis control and leprosy
eradication programmes.
The data relating to these two diseases in the two
centres for 1990 are given below.
Rural Health Centre
Urban Health Centre-
Leprosy Tubrculosis Leprosy Tubeculosis
•
Number of
cases Registered
26
26
132
53
•
Number of
cases on
Treatment at centre
25
25
75
16
•
Defaulter Rate
3.8%
3.8%
10.6%
6.3%
Nutritional Services
a) Vitamin ‘A’ Prophylaxis
Under this programme aimed at combating nutritional
blindness in children,200000 I.U of concentrated Vitamin
‘A’ solution is administered orally once in six months to
children between 6 months and 6 years of age. With the
successful implementation of this programme the
prevalence of Bitots’spots has declined to a negligible level
in these areas.
Administration of Iron and Folic Acid
b)
All expectant and lactating mothers are provided iron
and folic acid tablets for a maximum of 100 days as
prophylaxis against anaemia during pregnancy and
lactation.
Health Indices
Some of the important health indices for the two health centres in 1967 and 1990 are shown below.
Urban Health
Centre
1967
1990
Pondicherry
India
Indices
Rural Health
Centre
1967
1990
1989
1989
Birth rate (a)
Death rate (a)
Maternal mortality rate(b)
Infant Mortality rate (b)
Neonatal Mortality rate (b)
Couple protection rate (per cent)
41.2
17.2
6.8
120.0
*
*
38.4
14.8
0
148.0
*
*
22.4
8.0
*
35.5
*
32.0
10.8
2-6
95.0
*
58.3
37.5
20.3
8.7
0
47.4
8.6
50.8
17.5
7.4
0
53.3
33.3
53.0
* Data not available.
Source: 1. Bulletin on Rural Health Statistics in India. Dec. 1989 DGHS, New Delhi.
2. Annual Report for 1967 and 1989 of the Directorate of Health and Family Welfare Services,
Government of Pondicherry.
(a) Per 1000 population, (b) Per 1000 live births.
... ...
° i Ct(^c>
COMMUNITY HEALTH CELL
326, V Main, I Block
Kpramongala
®«ngalore-660034 -
Indi*
12
RURAL HEALTH SERVICES MOBILE CLINIC
The Rural Health Services Mobile Clinic Programme
commenced its services in August 1980 as one of the
activities under the Reorientation of Medical Education
(ROME) Scheme of the Ministry of Health and Family
Welfare Services, Government of India. The ROME scheme
was launched in all the Medical Colleges of the country in
1977 to make medical education more need-based and rural
community oriented.
Objectives of the scheme
The overall objective is involvement of medical
colleges in community health problems and direct delivery
of total health care services in the selected community
development blocks adjoining the medical colleges through
a well knit referral system.
The specific objectives are:
i)
to provide community orientation to the students
and teachers of medical colleges and
ii)
to upgrade the quality of heath care services in
rural and peripheral areas with provision of exper
tise and assistance in specialised services.
Planning and Coordination
As per the guidelines of the Ministry of Health and
Family Welfare, two committees for planning,
co-ordination and implementation of the activities were
constituted at JIPMER in 1980. These are the ROME
Scheme Advisory -cum-Coordination Committee and the
ROME Scheme Implementation Committee. The Head of
Department of Preventive and Social Medicine is the
Member- Secretary of the two committees.
13
Appointment of Staff
The present staff under the scheme includes Associate
Professor-cum-Ficld Epidemiologist (1), Medical Officer
(1), Social Scientist (1), Male Health Superviser (1), Public
Health Nurse (1), Stenographer (1), Driver (3), Male
Nursing Attendant (1) and Safaiwala (1).
Designation of Primary Health Centres
For implementation of the scheme and to provide
comprehensive health care to the rural community as
envisaged in the objectives of the scheme six Primary
Health Centres were designated by JIPMER (Fig. 1).
The details of these centres arc as follows:
Number Population
of villages
covered
catered to
SI. Name of
No. Primary Health
Centre (Location)
1.
Ramanathapuram (Under JIPMER)
12
16,014
2.
Kalapct (Under Govt, of Pon
dicherry)
14
13,520
3.
Kirumampakkam
(-do-)
18
17,000
4.
Thavalakuppam
(-do-)
16
10,379
5.
Katterikuppam
(-do-)
26
11,300
6.
Vanur(Under Govt, of Tamilnadu)
24
31,636
14
Mobile Clinics
JIPMER received three mobile clinic vans under the
‘ROME’ scheme. These vans are equipped to serve as
mini-hospitals on wheels. The objectives of these clinics
are:
i)
to orient the medical faculty, residents, interns and
medical students to health conditions prevailing in
rural communities and train these health personnel
in the management of health problems encountered
there, and
ii) to render comprehensive health care services with
emphasis on specialists’ care to the rural com
munity in collaboration with the staff of the health
centres.
The Mobile Clinic started its services at
Sanjeevirayanpet village 10 kilometres away from JIPMER
on 4th August 1980.
Organisation of Camps
The mobile clinic provides services by rotation to all
the villages covered by the six designated Primary Health
Centres.
After selecting a village for the camp a meeting is
arranged with the village leaders and staff of the concerned
Primary Health Centre to obtain their active support and
participation in the programme. Every month a five-day
camp is organised in the selected area. During the camp
specialists from the departments of Ophthalmology,
General Medicine, General Surgery, Paediatrics, Ear, Nose
& Throat, Obstetrics & Gynaecology, Dermatology &
Sexually Transmitted Diseases and Dentistry visit the clinic
on different days as per a schedule for providing
15
consultancy services. The mobile clinic is stationed
continuously in a village during each camp.
Interns, Junior and Senior Residents arc posted on
rotation to work in the mobile clinic during the camp.
Till 31st March, 1991, one hundred and three camps of
five day duration have been held and about 1,41,700
patients have utilised the services of the clinics.
These mobile clinic vans have also been utilised to
conduct about 25 one day camps for students to participate
in medical care, measles immunisation and for collection of
blood from voluntary donors.
Collaboration with Other Agencies
The health centres actively collaborate with various
departments and agencies in an attempt to have a holistic
approach to the provision of health care to the community
served and also to avoid duplication and to improve the
efficiency of services.
These agencies are:
A. Government of Pondicherry
o Department of Health & Family Welfare
- Deputy Director (MCH and F.W.)
National
- Deputy Director (Immunisation)
Health
- District Tuberculosis Centre
Programmes
- Control Units for Malaria, Filariasis,
- Leprosy and Diarrhoeal Diseases
- Public Health Laboratory
a Department of Social Welfare
(ICDS cell)
ICDS Scheme
a Department of Education
School
Health
Programe
a Project Executive Officer,
Villianur
Community
Development
16
a Pondicherry Municipality
B.
Government of India
o Mobile Food&NutritionExtcnsionUnit
C
Registration
of Vital
Events
Nutrition
Demonstra
tion &
Education
. Other Agencies
o Central Technical Committee,
AIIMS, New Delhi
ICDS
training,
continuing
education &
research
o Voluntary Agencies
Training &
Health
Education
17
COMMUNITY
HEALTH
TRAINING
The department provides training in community
health to medical students, medical interns and other
categories of health personnel.
The details of the training are described below:
A. Medical Undergraduate Students
a) First MBBS (Pre clinical phase)
The course is intended to enable the students to
understand and appreciate the concept of health and disease
and the factors which determine the maintenance of health
status in a dynamic equilibrium and to become aware of the
health care delivery system in the rural and urban areas and
the emerging roles of doctors in the context of "HEALTH
FOR ALL". It also provides a focus on the study of human
behaviour and consideration of family as a unit of the
community. It further provides opportunities for developing
communication skills and assuming role as a health team
leader.
Concept of health is covered through clinical case
demonstrations and small group discussions after brief
introduction. Such exercises are conducted using examples
of protein energy malnutrition, behavioural problems such
as alcoholism, drug dependence etc. Students are
introduced to the health care delivery system and the
services provided in rural situations by the government,
voluntary and private sectors through visits. The trainees
gain insights into the health services available and also the
health team concept at the health centre level. Visits are also
organised to various functional units of hospitals such as
medical records, central sterilization services, pharmacy,
nursing care services etc. Hospital visits again are utilised
18
to stress the team concept on one hand and the cost control
of medical care on the other.
The learning experience to the study of human
behaviour and concept of family as a basic unit is provided
by visits to families in rural and semi urban settings. The
students collect data concerning demographic and socio
economic factors, health beliefs and practices and
nature/pattern of utilisation of health care services through
simple proformae. These are presented and discussions are
held.
The art of interviewing and establishment of good
doctor - patient relationship are arranged through role play,
video demonstration etc.
The sessions outlined above are conducted in
collaboration with the departments of Anatomy,
Physiology, Paediatrics, Psychiatry and other units of the
institute.
b) Second MBBS (Clinical phase)
The students of second MBBS class participate in
Family Health Advisory Programme and arc provided
training in community diagnosis. They also become
acquainted with the implementation of different National
Health Programmes.
i) Family Health Advisory Programme
This is a community based programme organised
during clinical period for two terms at the urban health
centre. It is aimed to enable the students understand and
appreciate the concept of family as a basic unit of a
community; to observe the ecological factors influencing
the health and disease of the family and the community; and
to demonstrate the concept of TEAM work, continuity of
care and optimum use of available resources for the benefit
of the individual, family and community.
19
Details of the Programme
One family is allotted to each team of two or three
students. The family selected include those with an
expectant or nursing mother, an infant or toddler, a chronic
disease like tuberculosis, leprosy etc. The students follow
the families for a year i.e. two terms through weekly visits
under supervision of the medical faculty and staff of the
health centre. Assesment of the students is carried out both
concurrently and terminally through a) discussions during
or after visits to the family b) maintenance of Family Health
Record book c) family case study presentations and d)
sessional and terminal tests.
ii) Training in Community Diagnosis
As a measure to modify the existing system of medical
education for imparting community based training to
medical students, the Medical Council of India
recommended ‘Community Medicine Posting’. This is
being implemented by the department since February, 1980.
The students are posted for a month during their second
clinical year in batches of twenty each for three hours daily
in the forenoon.
The educational objectives of this training are to
enable the students to
a)
acquire skills in planning and conducting village
health survey for arriving at a community diagnosis
and
b) prepare a plan for community therapy by utilising
the available resources.
The students visit daily the villages of one of the six
designated primary health centres (see page 13). They also
visit the local primary health centre, block development
office and other development agencies for an on the spot
observation of their activities.
20
The trainees also conduct village leaders meeting,
health education programmes and clinico-social case
studies.
Mobile clinic service programme is also arranged
simultaneously in these villages so as to integrate the
training component with service (see page 14).
In the entire programme the students arc encouraged
to organise all the activities independently. The faculty of
the department merely act as catalytic agents.
The students present and discuss their findings making
use of different audio-visual aids.
Feed back from students indicate that the training is
beneficial and of practical utility. The programme makes
them understand the conditions existing in the rural areas
and the need for a multi sectoral approach to solve these
health problems.
iii) Observational Visits to Other Health Agencies
The students visit the various units and agencies
implementing the different National health and disease
control/eradictaion programmes in Pondicherry and make
on the spot study of their activities. These units include
those for leprosy, tuberculosis, malaria, filariasis, cholera
and diarrhoeal diseases, immunisation services, registration
of vital events, health insurance and community
development.
B. Medical Interns
.
The medical interns undergo training in community
medicine for six weeks each in the urban and rural health
centres, posting in rural area being a residential one.
The training is provided through their participation in
the ongoing aelivities/programmes of the centres with
special emphasis on the ‘Health Team Concept’. The interns
take part in all the service, training and research activities.
During their posting the interns
21
gather experience in institutional and domicilliary
management of common health and disease
problems
b)
become familiar with community education and
liaison activiities for the utilisation of available
community resources
c) participate in the training/orientation programmes
for undergraduate medical students, health workers
and traditional birth attendants and
d) associate with the ongoing studies pertaining to
community diagnosis, health care delivery etc.
The assessment of the interns’ training is carried out
through their presentations in weekly seminar or of small
projects/studies conducted on various aspects of primary
health care and maintenance of performance diary.
C. Medical Post-Graduate Students
Medical postgraduate students of M.D. Community
Medicine are provided in depth training for about 2 months
in the administration/management and organisation and
provision of health care services in the health centres.
D. Other Health Personnel
Training/orientation on different aspects of
community health care is provided periodically for varying
duration to
i) Students of B.Sc. courses in Medical Laboratory
Technology and Medical Record Science.
ii) Field trainees of diploma course in Health Educa
tion (DHE) from Gandhigram (Tamil Nadu)
iii) Public Health Nursing Trainees from New Delhi
iv) Nurses attending the periodical orientation courses
in Paediatrics and Orthopaedics and
a)
COMMUNITY HEALTH CELt
326. V Main, I Block
kofanibngais
Bangalora-56Q034,
Indi*
22
v)
E.
Traditional Birth Attendents.
Integrated Teaching
The deaprtment has adopted integrated approach in the
teaching/training of medical students on various topics.
These include a) growth and development and behavioural
problems like alcoholism and drug abuse for pre-clinical
students in collaboration with the departments of Anatomy,
Phsyiology, Paediatrics and Psychiatry b) some aspects of
epidemiology like case control studies to first clinical year
students in collaboration with the department of
Radiotherapy and c) epidemiology and control of leprosy
and sexually transmitted diseases to second clinical year
students in collaboration with the department of
Dermatology and Sexually Transmitted Diseases.
F. Students Assignments
Clinical Students get opportunities to undertake
summer study projects funded by Indian Council of Medical
Research under the ‘studentship’ scheme. The studies
conducted by students include those on prevalence of
vitamin ‘A’ deficiency, epidemiology of leprosy in a rural
area, immunisation coverage among children 12-23 months
of age and knowledge, attitude and practice (K.A.P)
regarding antenatal care among expectant mothers.
The students are also encouraged to take up short
assignments out of their class hours. During 1990 a batch
of first clinical year students volunteered and conducted a
case control study on the risk factors in the development of
oral cancers under guidance of the faculty of the department
and that of Radiotherapy. These students presented and
discussed their findings with their own peer group viz. the
rest of their class. Such assignments have become popular
with students.
23
PARTICIPATION IN OTHER COMMUNITY
ORIENTED HEALTH PROGRAMMES
The department has been actively involved in
implementation of the National Health Programmes. Some
of these programmes arc :
1.
Universal Immunisation Programme
2.
Integrated Child Development Services Scheme
3.
National Leprosy Eradication Programme and
4.
National Goitre Control Programme.
Universal Immunisation Programme
This programme was launched in November 1985 by
Government of India with a view to achieve
IMMUNISATION FOR ALL by 1990’. It gathered
momentum in the Union Territory of Pondichery in 1986. It
envisaged collaboration of medical colleges with the
Department of Health & Family Welfare Services of the
respective states and union territories in a) the
immunisation coverage b) organising training programmes
for medical and other health personnel c) assisting in the
disease surveillance and d) conducting an independent
evaluation of the programme.
At JIPMER this department co-ordinates with the
office of the Deputy Director (Immunisation) of the State
Department of Health in the implementation of this
programme.
a) Training of Medical and Health Personnel
Since 1986 training programmes for various health
functionaries have been organised by the department in
collaboration with the department of Paediatrics and the
Directorate of Health and Family Welfare, Government of
Pondicherry and with the active support of Government of
India, World Health Organisation and UNICEF.
1.
24
The details of training provided til March 1991 are
shown below.
SI. Category of Personnel
No. Trained
No. of
Courses
Held
No. of
Personnel
Trained
1.
Medical Officers (including
Senior Health Administrators and
3 Child Development Project Of
ficers)
8
149
2.
Paramedical Staff
10
304
3.
Anganwadi Workers
(and their supervisors)
11
481
4.
Community Health Guides
2
24
5.
Traditional Birth Attendants
2
22
T
b) Immunisation Coverage Evaluation Survey
The department has conducted four successive annual
independent evaluation surveys since 1988.The important
components of these surveys are:
1. Immunisation coverage of children (12-23 months
old) and antenatal mothers.
2. Knowledge, attitude and practice(KAP) of mothers
regarding immunisation.
<•
3. Antenatal care utilisation.
4. Estimation of prevalence of paralytic poliomyelitis
through lameness survey among children below five
years and
5. Nonatal death survey for estimating mortality due
to neonatal tetanus.
25
i) Immunisation Coverage
The Immunisation coverage in this territory during the
last four years are shown below:
Percentage Vaccination
Vaccine
1988
1989
1990
1991
B.C.G.
81.5
96.0
96.0
98.0
D.P.T.
91.5
97.0
98.0
98.0
Oral Polio
91.5
97.0
98.0
98.0
Measles
39.0
80.0
88.0
96.0
Including Measles
35.0
74.0
83.0
90.0
Excluding Measles
79.0
91.0
94.0
94.0
94.3
98.0
99.5
99.5
a) Infants
Fully Immunised
b) Antenatal Mothers
Tetanus toxoid
ii) Prevalence of Paralytic Poliomyelitis
The prevalence of paralytic poliomyelitis per 1000
children below five years in Pondicherry in 1989, 1990 and
1991 are 4.4, 2.3 and 1.3 respectively.
c) Surveillance of the Six Vaccine Preventable
Childhood Diseaes
The surveillance activities for these diseases is co
ordinated in close collaboration with the Deputy Director
of Immunisation. Steps arc also taken to conduct detailed
epidemiological investigation of every case of paralytic
poliomyelitis reported from the Pondicherry region.
26
2. Integrated Child Development Services (I.C.D.S)
Scheme
The head of this department is the Consultant for this
scheme. As envisaged in the scheme training/orientation
programmes are regularly organised for medical officers,
Child Development Project Officers(C.D.P.Os), anganwadi
workers and their supervisors.
In addition annual surveys were conducted in February
1990 and 1991 in the rural project of the Karaikal region.
3. Internal Evaluation of National Leprosy
Eradication Programme in Pondicherry
The department conducted an INTERNAL
EVALUATION of the implementation of the National
Leprosy Eradication Programme in Pondicherry prior to the
Independent Evaluation of this programme jointly by
experts from World Health Organisation and Government
of India in February, 1986.
The internal evaluation was conducted from 6th to
22nd January 1986 and a comprehensive report containing
the assessment findings and the recommendations was
submitted to the Directorate of Health and Family Welfare
Services, Government of Pondicherry. This report was
appreciated by all the members of thelndependent
Evaluation Team which visited Pondicherry.
4. National Goitre Control Programme
This department in collaboration with the departments
of Paediatrics, Surgery and Medicine and Directorate of
Health and Family Welfare, Government of Pondichery
organised a one day training programme in March, 1989 for
medical officers and other health personnel for conducting
survey and detection of cases of goitre in this region.
27
CONCLUSION
We believe that these efforts have contributed
significantly towards the development of community
orientation of doctors and need based community health
services. The efforts will continue in the future also.
- Media
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