UNIVERSAL IMMUNISATION.pdf
Media
- extracted text
-
REPORT ON THE
TRAINING OF MEDICAL AND HEALTH PERSONNEL FOR
THE
UNIVERSAL IMMUNISATION PROGRAMME
IN PONDICHERRY
DEPARTMENT OF
PREVENTIVE AND SOCIAL MEDICINE
JAWAHARLAL INSTITUTE OF POSTGRADUATE MEDICAL
EDUCATION AND RESEARCH
PONDICHERRY
1991
REPORT ON THE
TRAINING OF MEDICAL AND HEALTH PERSONNEL FOR
THE
UNIVERSAL IMMUNISATION PROGRAMME
IN PONDICHERRY
Edited by
D.K. SRINIVASA
&
M. DANABALAN
DEPARTMENT OF
PREVENTIVE AND SOCIAL MEDICINE
JAWAHARLAL INSTITUTE OF POSTGRADUATE MEDICAL
EDUCATION AND RESEARCH
PONDICHERRY
1991
RB15-3
Phototypeset and Printed at All India Press
Kennedy Nagar, Post Box No. 51
Pondicherry-605 001 —India
Phone:24979
Contents
Acknowledgement
1
Introduction
2.
Objectives of the Training
3.
Contents of the Programme
4.
Methodology
5.
Evaluation
6.
Training of Medical Interns
7.
Conclusion
8
Table-1
Annexures I & Il
Acknowledgement
Grateful thanks to:
Director of J1PMER, the Directors of Health and Family Welfare Services and
Social Welfare of the Government of Pondicherry, for their permission to conduct
the training and for deputing the staff,
The Directorate General of Health Services and Assistant Commissioner
(Immunisation), Ministry of Health and Family Welfare, for the financial and
other support,
Deputy Director (1), Deputy Director (FW & MCH), Joint Director and Programme
Officer (ICDS), faculty members of the departments of Paediatrics, Microbiology
and Preventive and Social Medicine (P & SM) for the help in various phases of
the training.
Dr. R.N. Sahoo, Mrs. C. Maragathamani and Mr. A. Palanikumaran of the
department of P & S M for assistance in the preparation of the report.
UNICEF for the financial grant and for the supply of training modules.
i. Introduction
The Government of India, Ministry of Health and Family Welfare started a scheme
in 1985 with the aim of achieving universal immunisation coverage as a part of the
Expanded Programme on Immunisation and improving management of diarrhoeal
diseases and also providing prophylactic treatment against nutritional anaemia
with iron and folic acid to women with haemoglobin levels of 10 gm. per cent and
children with levels of 8 gm. percent in the country as a whole to be achieved by
1990.
Pondicherry was one of the union territories included in the initial phase of the
Universal Immunisation Programme. The programme envisaged the involvement
of medical colleges by utilising the services of medical students and faculty to support
health departments in improving immunisation coverage, planning and organising
training of medical and health personnel, assist surveillance and conduct of in
dependent evaluation programmes. The department of Preventive and Social
Medicine of the Jawaharlal Institute of Postgraduate Medical Education and
Research (J1PMER) was to organise and conduct these activities in the Union
Territory of Pondicherry.
The health services infrastructure in Pondicherry consists of nine major hospitals
including JIPMER, 3 Community health centres, 11 Primary health centres, 70
sub-centres and 26 dispensaries. Under the ESI scheme, there are 11 dispensaries
besides a 50 bed hospital.
In addition to this, there are 677 Anganwadis of the Integrated Child Development
Services scheme (ICDS) actively co-ordinating in the immunisation and other
health programmes.
JIPMER commenced the training programmes of medical and health personnel
in October 1986. These programmes were systematically planned and conducted
in a sequential manner. Usually, after completing training of a batch of medical
Officers, the training of health assistants, health workers and the Anganwadi
workers was undertaken from the same Community health centres, Primary health
centres, sub-centres and ESI dispensaries so as to develop an effective, motivated
and trained team for those areas.
The particulars of the training courses held from 1986 to 1991 are shown in Table-1
and Annexure I.
2.
Objectives of the Training
Initially, the training was related to the Universal Immunisation Programme (UIP)
components only. Later on integrated training courses for the programmes ad
dressed to the women and children were organised as per the recommendations of
the ministry of Health and Family Welfare and the Central Technical Committee
of the ICDS. These integrated programmes included UIP, Diarrhoeal Diseases
control programme (DDC), Acute Respiratory Diseases control (ARI) and the
ICDS. To meet these goals suitable training objectives were drawn. It was expected
that the training would enable the participants to develop the following abilities:
Universal Immunisation Programme
1.
Prepare a plan of action and chalk out strategies of implementation for the
coverage of eligible children and pregnant women in the PHC areas.
2.
Arrange a briefing session of concerned staff to explain the objectives of
the programme and the strategies of implementation.
3.
Place an indent for the required quantities of vaccine with the Deputy Director
(Immunisation), Govt, of Pondicherry. Maintain cold chain properly in
PHC and in the outreach as per recommendations (i.e. — 2 to 8C).
4.
Check that all supplies and equipment required are available.
5.
Arrange for wide publicity to encourage community participation.
6.
Ensure regular monitoring and supervision of work.
7.
Ensure completion of recommended immunisation schedule at the right age.
8.
Send monthly feed back to the Deputy Director (Immunisation).
9.
Participate in the epidemiological evaluation programme.
Diarrhoeal diseases programme management
10.
Perform the following steps whenever the child is brought with diarrhoea :a) Assess the degree of dehydration by clinical examination.
b) Select treatment plan to prevent or treat dehydration.
c) Collect stool specimen by anal tubing method and transport of the same
to the nearest laboratory for confirmation.
d) Record the data.
11.
•
Perform the following steps to implement Oral Rehydration Therapy Pro
gramme
a) Train Para-medical Workers in the health centre area,
b) Plan and supervise educational programmes for mothers.
c) Ensure supply of oral rehydration salt (ORS),
•d) 'Mqnitor and supervise the ORT programme,
' \e)-Advi^mothers about feeding during and after diarrhoea,
f)„gxpl^iri td'fh'b. mothers about the inter-relationship among nutrition,
-infection and diarrhoea.
' ?‘r
Management of AcutetRespiratory Infections
12.
Perform the following steps whenever a child is brought with Acute respiratory
infection (ARI):
a) Assess the clinical severity of ARI viz: mild, moderate and severe,
b) Select treatment plans to treat ARI and to impart health education to
prevent the same,
c) Recording of the data.
1CDS components
1.
2.
3.
4.
5.
6.
3.
Be aware of the objectives, organisation and resource allocation of ICDS.
Identify the beneficiaries and the benefits under the ICDS programme.
Take effective part in the implementation of health components of the scheme.
Plan and implement continuing education for Anganwadi workers.
Be aware of the role of State Coordinator and Consultant of ICDS.
Prepare and transmit monthly reports.
Contents of the Programme
Under the Universal Immunisation Programme, the following topics were
covered
1)
2)
3)
4)
5)
Management of the cold chain system,
Conducting vaccination session,
Evaluation of vaccination coverage,
Conducting disease surveillance and
Manual of Health Workers.
Under the Oral Rehydration Therapy Programme, the following topics were
covered
Treatment of diarrhoea,
l)
2) Diarrhoeal disease control programme and
3) Nutritional care during diarrhoea.
Under the ICDS programme, the following topics were covered
Introduction, concept, objectives and organisation,
Role of State Co-ordinator and Consultant,
Monitoring and continuing education system for health components and
its feedback,
4) Administrative and financial aspects of ICDS,
5) Social welfare components, its functioning and reporting,
6) Contents of continuing education programme at the project/PHC level
with its review and implementation,
7) Discussion on MMR and MPR-Reporting
8) Monitoring of growth and development,
9) ARI and its management.
1)
2)
3)
Methodology
Group discussion
For universal immunisation aspects, small group discussions and short presenta
tions by guest faculty were the techniques adopted. Participants were encouraged
to take part actively in small group discussions. Self study of modules prepared
by the ministry of Health and Family Welfare of the Govt, of India on UIP and
ORT and supplied by the UNICEF were used.
Demonstration
The method of assessing dehydration in children was demonstrated with the help
of cases brought from the hospital. The three components, i.e. history taking (ask),
observation (look) and clinical examination (feel) were emphasised during the
demonstration.
Facilities are available for the laboratory confirmation of poliomyelitis at JIPMER.
The method of collection, storage and transportation of specimen for laboratory
investigations of suspected cases of poliomyelitis was also demonstrated.
Guest lectures
Guest lectures were delivered on some topics. They were followed by intensive
discussions.
Use of A.V. aids:During the entire course, a number of 35 mm. transparencies, extrans, overhead
projections and video clips were used. Three video films on rationalised use of drugs
and acute respiratory' infections were shown.
Faculty/Guest Lecturer
The resource persons were from the departments of P& SM. Paediatrics and Micro
biology of JIPMER. The guest lecturers were invited from the departments of
Health & Family Welfare Services and Social Welfare of the Govt, of Pondicherry.
The list of faculty members and guest lecturers is shown in Annexure-II.
5.
Evaluation
i) Pre and Post tests
In each course a pre and post test was conducted by using a questionnaire.
It was observed that the knowledge of about half of the medical officers in the
following areas was inadequate.
— Methods of estimating the vaccine requirement,
— Thermosensitivity of vaccines,
— Storage of vaccines in different parts of the refrigerator.
— Maintenance of cold chain system.
— Surveillance of vaccine preventable diseases.
The existing knowledge of health assistants (male & female) and health workers
(maie & female) on indications and contraindications of vaccination and steriliza
tion procedures to be taken to maintain the potency of vaccines during outreach
activities were some of the areas which needed improvement. Similarly the correct
immunisation schedule and interval between the doses were some of the aspects
which needed updating for the Anganwadi workers.
Following the training there was significant improvement of knowledge and under
standing in these aspects by the participants, (see the pre and post test scores)
Pre test
Post test
Mean
66%
83%
Range
50% to 78%
68% to 98%
Mean
68%
92%
Mean
52%
85%
Medical Officers:
Health assistants and
health workers:
Anganwadi workers:
if)
Programme Evaluation Results
The programme evaluation results indicated that the participants felt that:the objectives of the programme were specified by the course managers,
the methodology adopted encouraged their active participation and there
were opportunities for free discussion,
c) the learning atmosphere was friendly,
d) the background materials provided were helpful,
e) A.V. aids were adequately used,
f) training programme was useful and
g) eventhough the programme had a tight schedule, they had learnt a lot.
a)
b)
6.
Training of Medical Interns
It was decided to provide training to medical interns as well from 1988. The Depart
ment of Preventive and Social Medicine organised this training during the twelve
weeks posting of interns in the rural and urban health centres. The modules covered
in these training sessions were “Manage the cold chain. Conduct vaccination ses
sions and Evaluate vaccination coverage.” Copies of these modules were provided
by the southern zonal office of the UNICEF. During the period from 1988 to 1991
a total of 210 medical interns have undergone this training. This would be carried
out in future also for every batch of interns.
7.
Conclusion
The systematic training has improved the knowledge and motivation of the medical
officers, paramedical and anganwadi workers. Better supervision, timely supply
of vaccines, establishment of cold chain system and health education activities have
among other things contributed to the high coverage of vaccination of the target
group in the Union Territory of Pondicherry.
TABLE-1
Serial
Number
1.
2.
3.
4.
5.
6.
Category of Personnel trained
Medical Officers
Health assistants and health workers
Anganwadi workers
Trained dais
Community health guides
Medical interns
No. of
courses
held
No. of
personnel
trained
8
10
11
2
2
151
305
486
24
22
210
ANNEXURE 1
Particulars of Training Courses held from 1986 to 1991
Batch
Period of Training
Total no. of
Participants
MEDICAL
OFFICERS
I
II
III
IV
V
VI
VII
VIII
15-10-86 to 18-10-86
3-12-86 to 6-12-86
27-10-87 to 30-10-87
16-02-88 to 19-02-88
20-11-88 to 1-12-88
25-1-90, 27-1-90, 29-1-90 & 30-1-90
21-9-90, 22-9-90, 24-9-90 & 25-9-90
2-3-91 to 6-3-91
14
19
21
15*
18
19
20
25
HEALTH
ASSISTANTS
(M & F)
and
HEALTH
WORKERS
(M & F)
1
II
III
IV
V
VI
VII
VIII
IX
X
24-10-86 & 25-10-86
11-12-86 & 12-12-86
10-12-87 & 11-12-87
16-02-88 & 17-02-88
18-02-88 & 19-02-88
24-01-89 & 25-01-89
6-02-90 & 7-02-90
11-03-91 & 12-03-91
13-03-91 & 14-03-91
18-03-91 & 19-03-91
34
33
28
20*
25*
34
24
36
35
36*
ANGANWADI
WORKERS
I
II
III
IV
V
VI
VII
VIII
IX
X
XI
5-11-86
6-11-86
7-11-86
21-01-87
22-01-87
23-01-87
6-12-88
7-12-88
8-12-88
21-02-90
22-02-90
42
43
40
39
43
42
60
60
56
38
23
TRAINED
DAIS
I
II
21-02-90
22-02-90
14
10
COMMUNITY
HEALTH
GUIDES
1
II
21-02-90
22-02-90
12
10
MEDICAL
INTERNS
Training conducted at Karaikal.
210
ANNEXURE-II
List of Resource Persons Guest Lecturers
GOVT. OF PONDICHERRY
JIPMER
Department of Health and Family Welfare
Dr. D.K. Srinivasa.
Professor of P. & S. M.
and Consultant ICDS
Dr. Gilbert Benjamin.
Director of Health & FW,
State Co-ordinator, ICDS
Dr. R.K. Puri,
Former Prof, of Paediatrics
Dr. (Mrs.) Andree Karunakaran,
Deputy Director (Immunisation)
Dr. M. Danabalan.
Assoc. Prof, of P. & S. M.
Dr. V. Palanivelu,
Deputy Director (FW & MCH)
and Senior Adviser (ICDS)
Dr. S. Srinivasan,
Head of the Dept, of Paediatrics
Dr. MJ. Alphonse,
Deputy Director (ESI)
Dr. P. Nalini,
Assoc. Prof, of Paediatrics
Dr. M.A. Purushothaman,
Senior specialist Paediatrics
Dr. S. Badrinath,
Assoc. Prof, of Microbiology
Dr. K. Janaki,
Junior Specialist Paediatrics
Dr. S. Mahadevan,
Assoc. Prof, of Paediatrics
Dr. A.R. Nellian,
Junior Specialist Paediatrics
Dr. Ajit Sahai,
Assoc. Prof, of Biometrics.
Dept, of P. & S.M.
Dr. P. Thangaraj,
Medical Officer
(Contd. . . .)
ANN EX URE-II (Conid.)
Dr. M. Bala Soudarssanane.
Assl. Prof, of P. & S.M.
Dr. G. Ravitchandirane,
Medical Officer
Mr. G. Ramalingam,
Leet, in Stat. & Demography.
Department of P. & S.M.
Dr. Uma Sankar.
Medical Officer
Dr. G.S. Adinarayana,
Medical Officer
Dept, of Social Welfare.
ICDS
Mr. N. Arumugham.
Joint Director
Mrs. R. Chand Sultana.
CDPO
Mrs. A.P. Gandhimathi.
CDPO
Mrs. R. Gomathi,
Organiser, ICDS
Position: 1298 (4 views)