Health Care by Multipurpose Workers at Subcentre Level
Item
- Title
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Health Care by Multipurpose
Workers at Subcentre Level - extracted text
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01
Health Care by Multipurpose
Workers at Subcentre Level
Research in District Health Administration Rohtak
(W.H.O./Unicef Assisted Research Project)
BRIEF, pESUME OF WORK DONE BY
THE
RESEARCH
PROJECT
IN BOTH THE PHASES
Published by the Voluntary Health Association of India
New Delhi, by kind permission of NIHAE, Delhi
INTRODUCTION
1.0 In the overall organisational set-up of the health services in India the District
Health Administration with its responsibility for efficient and effective imple
mentation of both curative and preventive programmes is an important area for
careful study to identify those factors that can be modified for the maximumisation
of resources particularly with reference to limited material inputs which have
neither increased in proportion to demand for service in recent years nor are
likely to reduce the gap in the foreseeable future.
1.1 Due to the paucity of material resources, it has been felt that inorder to
rationalise the health Administration, within the given constraints an experimental
approach based on actual feed back from the field may alone give an answer to
efficient, effective and optimal functioning of the health administration at the main
system and its sub-system within the resources already available It is almost
certain that so long such an approach is not adopted it is difficult to expect any
improvement in the existing system. However, since independence, considerable
re-organisation and expansion have been undertaken to ascertain whether the
existing methodology of delivery of health care is adequate to achieve the
objectives of the programme and proper integration of the services. In the
absence of such a tested methodology, the validity or practical feasibility of the
decisions taken; to determine the organisational structure, the adequacy of staff
and funds, the skill required for specific activities, the job description; the work
load and the coverage of population etc., remains subjective since these sensitive
issues have been decided on hypothetical estimations rather than on objective
analysis and actual feed back form of the field situations.
OBJECTIVES OF STUDY
2.0 Against the background stated above, the techno-financial assistance of rho
WHO and UNICEF enable the NIHAE to undertake a Research Project on the
study of District Health Administration in the year 1970 with following objectives ■-
(a)
(b)
(c)
(d)
To make a comprehensive study of health services at the District level.
To assure most effective and efficient use of resources.
To assure integration of preventive and medical care activities.
To assist in orientation of the above mentioned personnel vis-a-vis
(b) and (c).
2.1 From this, it was intended to evolve a methodology for research in the
organisation of health services at the district level which could be applied
throughout India by the relevant authorities and to formulate recommendations
concerning the optimal organisation for district health services.
STUDY PLAN AND RESEARCH METHODOLOGY
3.0 In order to achieve the objectives, referred to above, the research design of
the studyenvisages to conduct the research in two phases. The comprehensive
survey of the district health administrations is an answer to the first objective of
the study and forms phase-I of the Research Project. This phase has been
planned as a diagnostic or descriptive study. The remaining objectives are
required to be relevant in phase-II which has been planned basically as a
manipulative or experimental study.
3.1 Besides sampling procedure, the phase-I study has been conducted by wav
of interviews and continuous observations of the personnel working in the
organisation of the district health administration. In addition data has been
collected from the records maintained at the different levels.
(
2
)
WORK DONE IN PHASE I
4.0 A comprehensive diagnostic study on the working of district health ad
ministration with particular reference to (a) Organisation and Administration
(b) Utilisation of Manpower and Material Resources and (c) Working of Health
Programmes has already been completed in Rohtak district of Haryana State to
wards the end of 1971. Likewise, a similar kind of rapid study has also been
conducted in Patiala District of Punjab in the month of February, 1972. The
findings of both the studies have been written in the form of a report and some
of the important findings emerging out of the studies are summarised below :
FINDINGS OF PHASE I
5.1
Organisation and Administration
5.1.0 The planning of the programmes is initiated and finalised at the State level
on the basis of the past performance and not on anticipations or projections. The
district and lower levels have no discretion in determining the policies and the
scope of activities.
5.1.1 The organisation of the district health services is designed for integration
of curative and preventive services. However, the programmes are still running
vertical. Due to vertical organisation of the programmes and uni-purpose working
of the peripheral field workers, the meaningful or desired amount of integrations
has not been achieved. The Programme Officers of the district as a supervisor,
maintain their separate entity and the Medical Officers of the periphery are not
playing the role of a co-ordinator or integrator.
5.1.2 Directionsand instructions from the State Directorate or the district are
non-specific and are not supported by the explanations of on the spot elucidation,
guidance or supervision.
5.1.3 The staff working at periphery has not been supplied with a copy of written
job description or detailed instructions as how to plan and arrange their
daily work.
5.1.4 No systematic orientation fora new entrant to the service is organised.
The inservice orientation is planned irregularly.
5.1.5 Coordination at the district level is confined mainly to family planning work.
Communication among the programme officers assisting the Chief Medical Officer
is unstructured and erratic.
5.1.6 There is not enough decentralisation of administrative and financial powers
from the state level to the main system, even for the matters of routine nature.
At the district level, all administrative and financial powers are vested with the
Chief Medical Officer, resulting in an unnecessary delay in programme operation
at the peripheral institutions. This is also resulting in ineffective control by the
Programme Officers and the Medical Officers of P.H.Os. over their staff.
5.1.7 The complaints of political interferences are common at all the levels.
5.1.8 Supervision at different level is superficial, unplanned and scanty. The
supervisory officers, irrespective of their status or category, pay a casual visit to
the field staff just to fulfil the official requirement of the specified number of tours
required to be performed by them.
5.1.9 Maintenance of records is poor due to improper designing of some of the
records of inadequate understanding thereof by the works. Separate records
for each service given are maintained by the workers due to vertical organisation
of the programmes. Periodical reports and returns are not scrutinised and
evaluated except in the case of family planning achievements. The data on
morbidity and vital events are not dependable due to defective recording.
5.2
Utilisation of manpower and Material Resources
5.2.0 The manpower and material resources deployed in achieving the objectives
of the programmes, under implementation, are either not properly utilised towards
(
3
)
the given goals in some cases or are under-utilised in other cases due to defective
methodology (i.e. single-purpose) of delivery of health care particularly at peri
phery. The Programme Officers of the district are spending only 52% of their
available time in activities and the remaining percentage is utilised in travelling,
unoccupied, absent from duty and personal work. At the P. H. C. level, @ the
engagement of the staff in actual work relating to job is nearly 33% of the
available time and the remaining percentage is utilised in travelling (i.e. only those
having itinerant job) and being unoccupied.
The table, given below, shows the general trend of time utilisation of some of the officers
and other categories working at the imain-system and its sub system.
Percentage break-up of available time
s.
No
Category of
Personnel
A.
Main System
*
1.
Chief Medical Officer
District F. P. & MCH Officer
District Malaria Officer
2.
3.
B.
**
Sub-System
1.
2.
3.
4.
5.
6.
7.
8.
Medical Officer
Block Extension Educator
Lady Health Visitor
Health Inspector
Sanitary Inspector
F. P. Field Worker
Basic Health Worker
Auxiliary Nurse Midwife
Vaccinator
9.
Time spent
in
activities
Time spent
in
travelling
Time spent
otherwise.
64.85
48.67
42.19
18.84
21.86
29.71
16.31
29.47
28.10
37.53
26.30
42.42
41.37
16.77
21.40
42.82
45.83
20.73
2.75
17.80
21.77
30.00
23.16
18.28
12.44
13.35
18.02
59.72
55.90
35.81
27.73
60.07
60.32
44.74
40.82
61.25
* Note :—Observational study on Deputy Chief Medical Officer (Health) could not be conducted
because of his non availability. As regards Deputy Chief Medical Officer (Medical),
he being a stationary officer observational study was not considered necessary in
his case.
** Note :—Some other categories of personnel like T. B. Multipurpose worker, laboratory
technician, dispenser, computer and clerk have not been covered by way of work
analysis but have been covered by work sampling.
5.2.1 Some of the factors responsible for inadequate utilisation of manpower as
shown above are : (a) Non-availability of job description with functionaries,
(b) Lack of orientation to the job and inadequate understanding of the objectives
and purpose of the activities, (c) Inadequate supervision and guidance in planning
of domiciliary roundsand arrangement of tasks, (d) Lack of discipline, (e) In
sufficient motivation and apathy for work, (f) Shortage of equipment and medicines
in the case of field workers, (g) Boredom with the monotonous repetition of the
activities, (h) absence of encouragement and appreciation, (i) Lack of amenities
and social life in the peripheral institutions.
5.2.2 In respect of material resources, the indenting of medicines and equipments
at the periphery is not rational. This is not centrally standardised or regulated
resulting in shortage at some places and surplus at other units. The instruments
and appliances supplied to the PHCs are not put to sufficient use. The physical
verification of the stores is seldom done either by the district officers or by the
Medical officers of the PHCs. The vehicles provided to the PHCs have been used
considerably for transporting cases of sterilisation but have been used very little
for the purposes of field supervision of the peripheral fieldworks. Most of the
Civil Hospitals are not rendering the role of referral hospitals.
(
5.3
4
)
Working of Health Programmes
5.3.0 The family planning programme has assumed over-whelming importance on
the other programmes. As a result, the other programmes have either been
neglected or given less attention than what was due in the perspective of an
integrated health programme.
Medical Care : The facility is available within the vicinity of the PHC or
other health institutions falling within the block area. No medical care is available
through the sub-centres. Consequently, the benefit is available to a small popu
lation and to a limited number of villages in which also the quality is not of a
reasonable standard. By and large, the community is depending more on private
practitioners of different systems of medicines.
5.3.1
5.3.2 Malaria Eradication : The active surveillance appears to be adequate in
view of the fulfilment of prescribed targets. However, the number of positive
cases is more than the permissible limit for an area to be under maintenance
phase. This reflects on the quality of surveillance done. The radical treatment
in most of the cases is usually completed within the prescribed time but the focal
sprays are generally delayed for want of squad, transport and D.D.T./B.H.C. etc.
Passive surveillance is very poor.
5.3.3 Small-pox Eradication : The accent is only on primary vaccination and
even here the coverage is not assessed against the actual births because the
vaccinator is not directly collecting this information. The primary vaccination is
given only to those new borns who are recorded in the register of the villagechowkidar. Consequently, a sizeable number of the children between the age
group of 1 to 10 years are unprotected in each area. The majority of adults are
not re-vaccinated.
5.3.4 Maternal and Child Health : This programme has been over-shadowed by
the Family Planning Programmes. There is no actual target laid for the coverage.
As a result little is achieved under ante-natal care or confinement care. Post
natal and infant care are almost omitted.
5.3.5 Family Planning : There is a constant drive to get more and more cases
for sterilisation. The survey of the populatian required to be done by the field
workers is not up-to-date. As a result there is no way to know, at any point of
time, how many couples are under the purview of a single worker and how many
of them have adopted family planning. No efforts are made for periodic follow
up of the IUCD cases. With the result, it is not possible to know how many
women are still retaining the IUCD. The expelled cases are mostly not recorded.
Contraceptives are distributed arbitrarily and indiscriminately without ascertaining
whether the recipients are making use of them or not.
5.3.6 T. B. Control : T. B. control has been organised only at a very low key
and is availed by only those who came to PHC. There is no system of active case
finding. Treatment is possible only in about 50% of the cases held.
5.3.7 Environmental Sanitation : Disinfectant of wells and persuation of the
people to remove rubbish heaps are the only two activities seen to be done by the
Sanitary Inspectors who are the field functionaries for this programme. The
chlorination of wells is done crudely and arbitrarily without proper dosing at
unspecified periodicity.
5.3.8 School Health Programme : The working of this programme is limited
to the extent of running a general out-patient clinic for the school children at the
district headquarters. No other activities as envisaged under the programme are
undertaken by the authorities responsible for this programme.
5.3.9 Vital Statistics : The department has no well organised system to collect
birth and death information. At the peripheral level, recording of birth and death
is the duty assigned to the Basic Health Worker and Auxiliary Nurse Midwife who
as a matter of fact give no attention towards this work.
(
5
)
CONCLUSIONS OF PHASE - I STUDY
6.0 The study findings have established it beyond doubts that there is ample
scope for reorganisation of the activities in the main system and its sub-system
which can help in better utilisation of the resources already available. It has been
realised that the effectiveness and efficiency of the main system cannot be assured
without introducing procedural changes at the Directorate level at the first instance.
However, such changes are beyond the assumptions of the study as the mainipulations are required to be introduced within the existing framework of the
organisation and administrative procedure. Nevertheless, it has been observed
that at the peripheral level a more effective and efficient method of delivery of
health care can be assured by introducing changes in the daily routine of activities.
Employment of the staff for single purpose programmes has resulted in dissipation
of energy in an unmanageable area of population while at the same time giving a
chance for the workers to rush through their work and get unoccupied for a major
part of the day. Undue stress on Family Planning and targets also gives an excuse
to the workers to deviate from a fixed schedule and move about aimlessly. In
the light of such findings, it appears that by regrouping the activities of the
programmes and by re-distribution of the duties at the peripheral level it should
be possible to achieve abetter coverage and improved quality of health care.
This kind of manipulations or interventions are the theme of Phase II of the
Research Project.
PREPARATION FOR PHASE - II
7.0 The initial thinking and responses from Health Authorities of the States of
Haryana and Punjab encourages the research team of the Project to plan for
Phase-II study in two districts (i.e. Rohtak and Patiala) of these States. However,
the subsequent events and the reservations expressed by the Health Authorities
of the concerned States reduced the operational area for Phase-II of the Research
Project from two districts to a peripheral rural healt unit (i.e. P. H. C. Kiloi of
Rohtak district) of a State. The technical preparations for Phase II, undertaken
from April, 1972 onwards could not be put into actual practice till September, 1972
even in an area of a P. H. C. because of various considerations of both human
and material resources.
THEME OF CHANGES IN PHASE-II
8.0 The main theme of the changes is an integration of the activities to provide
an integrated health care programme at the peripheral level through the para
medical workers (i.e. both male and female of peripheral and middle level).
Broadly, the manipulations introduced are :—
*
i)
To change the delivery of health care from vertical to horizontal fun
ctioning at the P.H.C. level and to ensure equal importance to all the
health programmes.
ii)
To convert the single purpose peripheral field worker and middle level
supervisor into an integrated health care worker
*
with the designations
of community health worker and health supervisor, respectively. This
would mean that the existing categories of peripheral field workers (i.e.
Basic Health worker. Family Planning Field Worker, Vaccinator and
Auxiliary Nurse Midwife) will form together a group of workers and will
be designated as Community Health Worker. Likewise, the functionaries
working at middle level (i.e. Block Extension Educator, Health Inspector,
Sanitary Inspector and Lady Health Visitor) would become supervisor of
integrated health care over four to five peripheral field workers and
would be designated as Health Supervisor.
The term multipurpose worker has purposely been avoided because of its vagueness and
confusion of terminology. No doubt functioning is. by and large multipurpose but to avoid
any confusion the term community health worker has been used.
(
iii)
iv)
v)
vi)
vii)
viii)
ix)
x)
xi)
xii)
xiii)
xiv)
xv)
6
)
To delimit the area of operation of the field workers within the radius of
three to four kilometers or one to three villages (as the case may be)
depending upon the population which must fall within the range of four
to six thousands in case of male worker and three to four thousands in
the case of female worker.
To ensure the delivery of integrated health care by the peripheral field
workers, for the area to be put under their respective charge. They will
be attending to all the health programmes in that area. This would
mean a new job description for them.
To reduce their travel time and to ensure effective utilisation of their
working hours.
To simplify recording system and procedure of reporting.
To introduce a programme of minor ailment in the domiciliary visits.
To strengthen the Maternal and Child Health Care Services by providing
direct and referral services.
To ensure proper utilization of each category of workers by deploying
them in the concerned programme or by assigning additional duties
relevant to their qualification, experience and working.
To bring about changes in the supervisory techniques by :—
a) Guidance, explanatory instructions and inservice training.
b) Helping in making day to day programme.
c) Demonstration of procedures and techniques.
d) Attending to the problems referred by the worker.
To ensure systematic and regular visits of Medical Officers and Lady
Health Visitor/Staff Nurse to the Sub-centres, so that the community may
know when to avail the doctor’s service through the sub-centres. Like
wise, to introduce a similar schedule of work for the middle level
supervisors.
To involve the other Rural Health Institutions, such as, Rural Dispen
saries, Government Ayurvedic Dispensaries and Civil Dispensaries etc.,
in the framework of the Primary Health Centre.
To introduce a proper referral service from field to sub-centre to P.H.C.
and P.H.C. to Civil Hospital/Medical College Hospital.
To evolve a regular system of collecting vital statistics (i.e. birth and
death).
■ To introduce a programme of immunization (i.e. D. P. T., Polio and
B. C. G.).
PLAN OF WORK FOR PHASE - II
9.0 In order to implement the proposed strategy, referred to above, the activities
of peripheral workers, middle level functionaries and Medical Officers have been
regrouped, a systematic schedule of work has been introduced at all the three
levels, a meaningful and simplified recording and reporting system have been
devised and above all a proper orientation to all the categories involved in the
experimentation has been given.
9.1 Job Description : A new set of job description for the health functionaries
working at the sub-system level has been prepared with an accent on integration
of activities or services (Refer Appendix-I).
9.2 Work Schedule : Systematic schedules for planning the works at different
levelshave been introduced so as to ensure a wider coverage of the health care
at the required number of intervals (Refer Appendix II to V B for tour pro
grammes).
(
7
)
Records and Equipment : The simplified redesigned records have been
introduced with a view to get more dependable and up-to-date information at one
place regarding the programmes under implementation. All the Community
Health Workers, depending upon their requirements, have been supplied
following records :—
9.3
a)
b)
c)
d)
Village Health Register (Specimen copy at Appendix-VI)
Malaria Form in register form (Specimen copy at Appendix-VII)
Ante-natal Register—only for female worker
(Specimen copy
Appendix VIII)
Referral Slips (Specimen copy at Appendix IX)
at
9 3.0 Besides this, all the C.H.Ws. have been supplied a kit bag in order to carry
the required equipments and records for the domiciliary visits.
Additional
contents of the kit bag are as follows :—
a)
d)
g)
Malaria kit-box
b) Vaccination kit
Towel
e) Soap with case
Plastic container for carrying medicines.
c)
f)
Forceps
Brush
9.3.1 The personnal working at the different levels of the experimental area are
submitting the progress report of the services undertaken by them. The proforma
for reporting the progress of the work are given at Appendix X and XL
9.4 Orientation Training: As a preparatory work for Phase-II, an orientation
training of a week's duration has been given separately to each existing category
of the workers for their conversion from unipurpose to integrated health care
workers. The curriculum of training broadly covered : (a) Concept of new
working methodology,
(b) Objectives of the programmes to be enforced,
(c) Techniques of undertaking activities under different programmes, (d) Revised
job description (i.e. of both the categories viz. Health Supervisor and CHWs),
(e) Guidelines to job description, (f) Techniques of supportive supervision,
(g) Objective of new recording and reporting system, (h) Maintenance of records,
(i) Preparation of daily progress report and
(j) Field demonstrations on the
points enumerated above.
9.5 Programmes Undertaken for Implementation : Based on the analysis of
Phase-I findings, the programmes selected tor implementation in Phase-II are
as follows :—
1.
2.
3.
4.
Small Pox
Malaria
M. C. H.
Family Planning
5.
6.
7.
8.
Medical Care
a) Ambulatory
b) Institutional
c) Domiciliary
Notifiable Diseases
Vital statistics
Immunization (i.e. D.P.T., Palio and B.C.G.)
9.5.0 Some of the other programmes such as Environmental Sanitation, Health
Education, School Health Scheme and Natrition have not been included under the
revised methodology. This omission is purposive as it is seen in Phase-I that
no attention, whatsover, is given to such programmes.
9.6 Preliminary Work : Befor commencing the actual work of proposed strategy
for Phase-II, the baseline data in respect of the experimental area has been
collected. For this purpose, all the villages/hamlets of the area have undergone
the following steps :—
a) Numbering each house in the village.
Appendix -1
JOB DESCRIPTION FOR THE PRIMARY HEALTH
CENTRE STAFF
A.
a)
PERIPHERAL FIELD WORKERS
HEALTH WORKER (Male)
The Community Health Worker will be the male paramedical worker at the
periphery to provide a basic level of domiciliary health cares. The existing cate
gories of Basic Health Workers, Family Planning Field Workers and Vaccinators
will together form the group of Communitty Health Workers. These workers will
be responsible to Medical Officer Incharge of Rural Dispensaries and Officers
incharge of Govt. Ayurvedic Dispensaries.
Each male Community Health Worker will look after a population ranging
between 4,000 to 6,000. He will visit 60 to 80 houses per day and each house will
be visited once a fortnight. His daily beat programme will be worked out by
taking the media of the following factors :—
a)
b)
c)
Population to be covered
Number of houses to be visited
Distance to be travelled
Duties :
1.
Small-Pox Eradication
a)
b)
c)
Primary vaccination
Re-vaccination
Check the Primary Vaccination done during the last visit and
repeat, if necessary.
2.
Recording of Birth and Deaths
3.
Malaria Eradication
a)
b)
c)
d)
4.
Detection of fever cases
Preparation of blood slides
Giving the presumptive treatment
Taking follow-up slides of the positive cases.
Medical Care
a)
b)
Detection of cases of minor ailments and giving them treatment
as per guidelines.
Referring difficult cases to the middle level Supervisors or sub
centre or Primary Health Centre according to feasibility.
10
,
*
5.
Family Planning & MCH
a)
b)
c)
d)
6.
COMMUNITY HEALTH CELL
•?"6’ v M"i". I Block
^oramong^la
Banga!ore-5G0034
Contact eligible couples and motivate them to accept F.P. methods.
Distribute contraceptives.
Notify to Middle Level Supervisors the cases that have been
motivated for sterilization. At least motivated cases should be
referred to each worker in a month.
Advise the ante-natal mothers to go to Sub-Centre; to report
about any problem cases or emergencies to the ANM/LHV.
Notifiable Disease Control
a)
b)
1.
’ '
/
Report cases of any notifiable diseases to the middle level super
visors or to the main centre without any delay.
HEALTH WORKER FEMALE (i.e. ANM)
Population : Each Auxiliary Nurse Midwife will look after a population
between 3,000 to 4,000 adjacent to the Primary Health Centre or Sub-centre where
she is posted. She will provide basic level health care in the community. She
will be responsible to Medical Officer Incharge of the P.H.C. through the Lady
Health Visitor. She will visit 30 to 40 houses per day and each house will be
visited once a fortnight.
Duties :
1.
Small-Pox Eradication
a)
b)
c)
Primary vaccination
Re-vaccination
Check primary vaccination done during the last visit and repeat,
if necessary.
2.
Recording of Birth and Deaths
3.
Malaria Eradication
a)
b)
c)
d)
4.
Medical Care
a)
b)
c)
5.
Detection of fever cases
Preparation of blood slides
Giving the presumptive treatment
Taking follow-up slides of the positive cases.
Conduct an out-patient clinic for an hour on each working day in
the afternoon and give treatment for minor ailments to all age
groups irrespective of sex.
Assist the Medical Officer and L. H. V. on the day of their sub
centre visit in examining the patients.
Refer emergencies and difficult cases to the P. H. C. or hospitals
according to feasibility.
MCH and Family Planning
a)
b)
c)
d)
e)
Registration of pregnancies
Rendering periodical ante-natal, post-natal care as per guidelines
Attending confinements when called upon, directly or by dais.
Guide the local dais.
.
Rendering infant and toddler care.
HTf- WO
Oi-^7
^!\------ .
L....... .
—------ -
(
)
Advise the ante-natal mothers for sub-centre attendance and
showing them to LHV or MO according to the convenience.
Contact eligible couples and motivate them to accept F.P. methods
Distribute contraceptives
Notify to middle level supervisors the cases that have been
motivated for sterilization. Each ANM should refer at least two
motivated cases each month.
f)
g)
h)
i)
6.
12
Notifiable Disease Control
Report the cases of any notifiable disease to the middle level super
visors or to the main centre without any delay.
7.
Middle level Supervisors
The existing categories of Lady Health Visitor, Health Inspector,
Sanitary Inspector and Block Extension Educator will form a group
of Health Supervisors.
c)
HEALTH SUPERVISOR (Female i.e. L.H.V./Staff Nurse)
The role of the Lady Health Visitor/Staff Nurse will be mainly supervisory.
In addition, she will render some services in the community in support of the
activities of the Auxiliary Nurse Midwife. All the Auxiliary Nurse Midwives of the
Primary Health Centre will be under her direct supervision. Her monthly pro
gramme will be chalked out in such a way as to allow her to conduct a clinic once
a week at the main centre and twice a month in all the sub-centres.
Duties :
1.
In Clinic
1.
2.
3.
4.
5.
6.
7.
8.
2.
Examination of ante-natal mother at least twice during the course
of pregnancy (2nd and 3rd trimesters) and ensuring examination
by the Medical Officer as early as possible.
Screening the cases according to ante-natal risks and advice and
refer, if necessary.
Immunization of ante-natal mothers with tetanus toxoid.
Examination of infants and children referred by the ANMs and to
take further steps, as necessary.
Immunization of infants with D.P.T./Polio.
Examination of other cases (Gynaecological, post-natal etc.)
referred by ANMs and give necessary treatment or refer to
Medical Officer.
Selection of cases of IUCD and insertion of IUCD.
Motivation of refusal cases in support of the ANMs work.
By way of Supervision of the A.N.Ms.
1.
2.
3.
4.
Check complete registration of ante-natal mothers, infants and
children.
Guide the ANMs in the performance of their duties and main
tenance of records and give demonstration of the procedures.
Arrange periodical supply of medicines, contraceptives, equip
ments required by the ANMs.
Collect blood slides taken by the ANMs to reach the PHC
Laboratory.
(
5.
6.
3.
d)
13
)
Home visiting for selected cases either referred by the ANMs or
to check her work.
Arrange for service to the motivated cases of F.P. for sterilization
etc. and follow-up.
Dais Training at Primary Health Centre.
HEALTH SUPERVISORS (Male)
Each Health Supervisor (Male) will have to supervise the work of 4 to 5
Community Health Workers. He will be supervising the work of each C.H.W. twice
a week. He will ensure consecutive and concurrent supervision over each worker.
Dut ies :
I
Supervision
1.
2.
3.
4.
5.
6.
Il
Check the visits, records, number of blood slides taken and quality
of blood smear and confirm the presumptive treatment given by
the CHWs.
Ensure complete coverage of primary vaccination in the area and
re-vaccination at required interval.
Check Birth/Death records maintained by the CHWs.
Guide the CHWs in the performance of their duties.
Arrange service to the motivated cases of F.P. ready to under-go
sterilization and follow-up.
Attend to any problem case referred by the CHWs and give it
treatment or refer according to the feasibility.
Supportive Service
1.
2.
3.
4.
5.
6.
Make regular supply of medicines, slides and contraceptives and
other equipments to the CHW.
Undertake radical treatment measures.
Arrange the timely despatch of the blood slides collected by
the CHWs.
Attend the refusal cases of the primary vaccination and blood
slides and ensure action to this effect.
Take necessary steps when notifiable diseases are reported.
Arrange for improvements of wells and chlorination, installation
of smokeless chullahs, installation of latrines pest destruction
of stray dogs with the assistance of any auxiliary male staff
available for the purpose.
There is a provision of three Medical Officers in each P.H.C., the senior
most being the incharge. The remaining two will assist the Medical Officer
Incharge in efficient and effective functioning of the P.H.C. The Medical Officers
have three areas of work—clinical, administrative and supervisory. Their pro
grammes will be so arranged in such a way that one Medical Officer is available
at the Primary Health Centre on each day to conduct the out-patient clinics and to
attend the indoor patients and emergencies. The other medical officer will either
conduct a clinic at sub-centres or supervise the work of the peripheral workers.
In the case of Lady Medical Officer she will be incharge of the clinics at
sub-centres and will supervise and support the services of the LHV/Staff Nurse,
ANMs and other female staff.
The male Medical Officer (Incharge or other) will supervise the work of
the CHWs and Health Supervisors and deal with administrative matters concerning
all the staff of the PHC.
(
a)
)
Duties of Medical Officer (Incharge)
I
Clinical
1.
2.
3.
4.
5.
6.
II
Organising and conducting the out-patients clinics at PHC
Organisation of the indoor service
Attending emergency cases
Attending medico-legal cases
Organising the laboratory service at the PHC
Referring cases to hospital
Administrative
1.
2.
3.
4.
5.
Guide and check the preparation of tour programmes of field staff
All matters relating to management of personnel
Reporting the progress of activities under all programmes to the
Chief Medical Officer
Liaison with other officials and agencies in the block
All matters relating to indents, receipts and maintenance of supplies
Supervisory
III
1.
2.
b)
14
Check and guide male workers in the field as well as in the
main centres.
Attend to problem cases referred by field staff and arrange for
appropriate services.
Duties of Ilnd Medical Officer (Male)
a)
Clinical
1.
2.
3.
4.
5.
6.
b)
Organising and conducting the out-patient clinics at PHC
Organisation of the indoor service
Attending emergency cases
Attending medico-legal cases
Organising the laboratory service at the PHC
Referring cases to hospital
Administrative
All work as and when assigned by Medical Officer Incharge.
c)
Supervisory
1.
2.
c)
Check and guide the male workers in the field as well as in the
main centres.
Attend to problem cases referred by field staff and arrange for
appropriate services.
Duties of the Lady Medical Officer
a)
Clinical
1.
2.
3.
4.
5.
Organise and conduct out-patient clinics at PHC
Organisation of indoor service
Attending medico-legal cases
Referring cases to hospital
Attending emergencies
(
6.
b)
c)
15
)
Conducting clinics at sub-centres and seeing referred cases and
arranging for their treatment.
Administrative
1.
Guide and check the preparation of your programmes of the
female staff.
2.
Reporting the progress of activities under all programmes of the
female staff to the Medical Officer Incharge.
Supervisory
1.
Check and guide the ANMs and LHVs in the performance of their
duties and maintenance of records.
2.
Provide appropriate service to cases referred in the field by the
peripheral staff.
Note—In case the services of the Lady Medical Officer are not available, the
work of supervising female staff will be decided by the Medical Officer
(Incharge).
Annexure III
LIST OF DRUGS TO BE SUPPLIED TO THE A.N.M’s.
For Internal Use
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
Tab. Sulphadimidine/Thiazole
Tab. Aspirin or A.P.C,
Tab. Sulphaguanidine
Tab. Sodamint
Tab. Unispasmin
Tab. Laxative
Tab. Vitamin A. and D.
Tab. Calcium Lactate
Tab. Multivitamin
Tab. Vitamin B. Complex
Tab. Vitamin C.
Tab. Ferrous Sulphate
Syrup Ferriphosphate
Mist. Alkline
Mist. Carminative
Mist. Sedative Expectorant
Mist. Stimulant
Mist. Bismuth Kaolin
Mist. Ferriet Ammonium Citrates
For External Use
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Whitfield's Ointment
Calamine Lotion O.LP.
Savlon
Eye Drops
Eye Ointment
Ear Drops
Dusting Powder
Throat Paint
Gentian Violet
10% D.D.T. Powder
11.
12.
13.
14.
Tab. Bensoinco
Gauze
Bandage
Cotton
Aeroflavene
Vaseline
Benzyl Benzoate
15.
16.
17.
16
(
)
17
EQUIPMENT FOR A.N.M’s.—For general use
1.
2.
3.
4.
5.
6.
7.
8.
9.
Clinical Thermometer
Swab Sticks
Spatula
Tape Measure
Weighing Machine
Pair of Scissors
Pair of Dissecting Forceps
Pair of Artery Forceps
Bowls for Lotions, Dressing etc.
Ante-natal Care
1.
2.
3.
4.
Urine Analysis-Kit
Haemoglobin estimation-kit
Foetuscope
Pelvimeter
Delivery Kit.
Appendix IV
MONTHLY FIXED TOUR PROGRAMME OF THE HEALTH
SUPERVISOR FEMALE (LHV/STAFF NURSE)
Weeks of a Month
Days of
a week
1st week
2nd week
3rd week
4th week
Monday
ANM’s HQ
S.C.-V
ANM HQ
S.C.-V
T uesday
S.C.-I
S.C.-VI
S.C.-I
S.C.-VI
Wednesday
s.c.-n
Open Day
S.C.-II
Open Day
Thursday
S.C.-III
S.C.-VII
S.C.-III
S.C.-VII
Friday
Ante-natal
Clinic Day
H.Q.
Ante-natal
Clinic Day
H.Q.
Ante-natal
Clinic Day
H.Q.
Ante-natal
Clinic Day
H.Q.
Saturday
S.C.-IV
s.c.-vm
S.C.-IV
s.c.-vm
Note—Open day is meant for surprise visit or any other work which is required
to be done.
Appendix VA
MONTHLY TOUR PROGRAMME OF THE MEDICAL OFFICER
(INCHARGE) OF P.H.C.
1
1
;l
Weeks of a month
Days of
!■
a week
1st week
2nd week
3rd week
Monday
P.H.C. Clinical
& Administrative
work
Open Day
PHC Clinical
& Administra
tive work
H.s.-n
Tuesday
S.C.-VI
S.C.-I
S.C.-VI
S.C.-I
Wednesday
PHC-Clinical &
Administrative
work
PHC-Clinical
& Administrative work
PHC-Clinical
& Administ
rative work
PHC-Clinical
& Administ
rative work
Thursday
s.c.-vn
S.C.-in
S.C.-VII
s.c.-in
Friday
PHC-Clinical
& Administ
rative work
H.S.-I
Open Day
PHC-Clinical
& Adminis
trative work
Saturday
PHC-Clinical
& Adminis
trative work
PHC-Clinical
& Administrative work
PHC-Clinical
& Adminis
trative work
PHC-Clinical
& Adminis
trative work
4th week
t
1
Note—Open day is meant for surprise visit or any other work which is required
to be done.
S.C. = Sub-centre.
»
18
Appendix VB
MONTHLY TOUR PROGRAMME OF THE 2nd MEDICAL
OFFICER OF PHC
Weeks of a month
Days of
a Week
1st week
2nd week
3rd week
4th week
Monday
S.C.-V
PHC-Clinical
work
S.C.-V
PHC-Clinical
work
T uesday
PHC-Clinical
work
PHC-Clinical
work
PHC-Clinical
work
PHC-Clinical
work
Wedensday
H.S.-III
S.C.-II
H.S.-IV
s.c.-n
Thursday
PHC-Clinical
work
PHC-Clinical
work
PHC-Clinical
work
PHC-Clinical
work
Friday
Open day
PHC-Clinical
wrker
PHC-Clinical
work
Open day
Saturday
S.C.-VIII
S.C.-IV
s.c.-vin
S.C.-IV
Note—Open day is meant for surprise visit or any other work which is required
to be done.
19
Appendix IX
Serial No
Date
Surveillance No
Village
Name of Person
Sex
I 4.
Age
Referred :
Medical Care/FP (Motivated)
MCH-Antenatal/com plicated
labour case/Postnatal/Infant
Notifiable disease.
Refusal
Blood slide/Primary Vaccination/
Revaccination/F.P. (Hostile)
Natvre of Case
:
( Strike out what is not Applicable )
Complaint
f
Service already given;
Signature of Worker
Referred/PHC/SC/Hospital
20
Appendix X
FORTNIGHTLY PROGRESS REPORT FOR THE MONTH OF.........19
1.
2.
Name of Worker
Sector/Section No.
I.
Dates of Visits
II.
Name of Village
3.
Name of P.H.C.
(Write vertically)
III.
Houses Visited
Form S.
To
IV.
V.
Locked Houses
Birth/Death Regd.
1.
2.
VI.
Small-Pox
1.
2.
3.
VII.
No. of births
No. of death
a) Infant
b) Maternal
c) Other
P.V. done
R.V. done
P.V. refused
Notifiable Disease
Cases notified
VUI.
Medical Care
1.
2.
Patient treated
(H. V.)
(S. C.)
Patient referred
(S. C.)
* (others)
*PHC/CH/Medical
College,
21
5.
6.
H.Q. of Worker
Name of Supervisor
(
IX.
)
Fever Surveillance
1.
2.
3.
4.
5.
X.
22
Fever cases detected
Slides taken
Tablets given
Refusal cases
Follow-up slides collected
Family Planning
1.
2.
3.
E. C. Contacted
C. C. Distributed
Motivated Cases referred
to Supervisor
Dates of Visits
XI.
Mother and Child Health
Antenatal visits
a) 1st visit
b) Revisit
2. Postnatal visits
3 Infant visits
B.
Centre Attendance
1. Antenatal
2. Infant
Confinements conducted
Risk cases referred to
PHC/CH/Medical College
C.
D.
Xn.
Tests
1.
2.
XHI.
1.
A.
Urine
Haemoglobin
T. B. Control
Slides prepared
Remarks (if any)
( Signature of Supervisor)
( Signature of Worker )
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