Divya Persai CHLP 2009-10-FR 45.pdf
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Community Health Learning Programme
May 2009 to July 2009
REPORT
Divya Persai
Intern, Community Health Cell
0
Introduction
Since childhood medical field fascinated me and that's the reason 1 joined dentistry after my
higher secondary schooling. In the third year of BDS I got acquainted with the concept of
public health dentistry and the subject gave me direction of what I wish to do in future .After
BDS I joined Masters of Public health (MPH) programme at Birla Institute of Technology and
Science BITS, Pilani .Rajasthan, where I read public health in depth and explored and gained
idea about the realm of this field in relation to various disease, national health programmes,
health management and intersectoral coordination in health care.
I was looking for a summer internship in order to have better understanding of public health in a
pragmatic sense. 1 came to know about the Community Health Learning Programme (CHLP)
and fortunately got selected as a flexible intern. I joined CIILP mainly to learn community
health at grass root level and to identify the loopholes in the public health system in India. Being
a dental surgeon, I was also interested in tobacco cessation methods, the functioning of the
tobacco cessation clinic which includes counselling, behavioural change and medication therapy.
My objectives while joining CHLP were:
• To understand the implementation of the health programme and the public health
system in the country
• To assess the quality of health services available
In view of understanding public health system, I studied the working of Employment State
Insurance (ESI) Medical system and the primary level health care provided by it. The objectives
behind my studies were:
•
To understand the implementation of ESI Act and the medical services provided
by it through the dispensaries
•
To understand the primary health care services available at the dispensaries
•
To understand the Tobacco cessation activities and the tobacco cessation act.
Implementation of National programme
Personal Goals
I also had some personal goals. They were:
•
To improve my skills in research methodology
•
To improve my skills in interviewing people
•
To improve my skills in documentation
PLAN OF ACTION ACCORDING TO MY LEARNING OBJECTIVES
OBJECTIVES
ORGANIZATION VISITED
ACTIVITIES
Understanding the Public health
system,health services and social
determninants of health
Understanding the working of an
NGO, Social determinants and
community participation in enhancing
health
CHLP Orientation programme
Understanding of concept of
health, globalization, gender
issues ,health for all etc
Exposure visit to understand the
atrocities faced by dalits, visit to
PHC and the school.
To Understand Anti Tobacco activities
Visit to Bangalore Medical college
Participated in No tobacco day
celebration
To understand the HIV/AIDS related
issues
Visit to MILANA
Meeting AIDS afflicted patients,
self groups formed by them & its
functioning
To understand the ES1M services and
organ gram
Visit
to
Workers
centre(WRC) office
To gave oral health education to the
children
Health education to children at
Workers Resource centre
Visit to Raichur: Jagaratha Mahila
Sangathan
Resource
To understand the functioning of ESI Visit to ESI Dispensaries
dispensaries and implementation of
ESI act
To understand the behavioural factors Attended Tobacco cessation clinic
related to tobacco addiction
NIMHANS
Meeting with Mr Gopinath,
discussed issues related to ESIM
services
Oral health education, hygiene
awareness and healthy living
practices education
Interviewing doctors, nurses etc.
Observe the functioning of the
dispensaries
Behavioural
and
medical
counselling for tobacco cessation
2
Learning from the orientation programme
Interns from different background and different places participated in the CHLP Programme,
interacting with them was a good learning experience for me.
Concept of comprehensive health care helped me to understand the ground realm of the
condition. I got insight on the primary health care services, concept of primary health care
deficiencies and strength of the existing public health system .infrastructure., integration of
AYUSH into National Rural Health Mission. Combine these two phrases. 1 got an idea about
Primary Health care and public health system problems and goodness though the PHC visit at
Potnal.
Class, Caste and Gender sessions gave me in depth knowledge of how different issues like
gender, patriarchy, marginalization of women’s rights are related to health, which in turn are
determinants of health in the socio-economic context. The documentary film on HIV give an
insight of the stigma attached to the disease and the social context of the disease, the
discrimination and the apathy associated with it.
FIELD VISITS TO RAICHUR
Jagrutha Mahila Sanghatan (JMS) Pothnal, Raichur Dt.
IMS is working with Dalit women and child labourers in Potnal, Raichur district. JMS is having
42 SHGs in 30 villages in 2 taluks. They have done many strikes and dhamas on violence meted
out to women and their rights. In JMS women are encouraged to come forward and share their
problems. JMS is working on issues related to PDS, NREGS, and RTI. They have Sanchalakies
team who work on Community Monitoring programme of National Rural Health
Mission,(NRHM). They also have units producing Herbal Medicine, Terracotta Jewellery and
neem fertilizer. They also have school for child labours.
First time after visiting JMS I got acquainted with the concept of sanchalakies. 11 Sanchalakies
are working in JMS as staff. They conduct the Sangha meetings, discuss various issues and then
finally come to decisions. They have got trainings and visited many places to see the other
organizations to understand their functioning. A group of 16 Members were involved in herbal
medicine preparation. From each village 2 members had been selected and they had gone to
different places to learn about herbal medicine. They have a clinic in JMS Pothnal. Patients
come to this place and get medicine. This herbal medicine is given for many problems like cold,
cough, jaundice, gynaecological problems, Mulawadi, Thannu (white marks on the body), Joint
pain, skin diseases, hair fall etc.
The terracotta unit has 15 members and they make products like jewellery, hangings and door
curtain of different types in clay and earn their livelihood from selling this product. Women
discussed about marketing, record keeping, book keeping and accounts maintenance.
We stayed in a school named Chilipili school. It was started 5 years ago primarily for children
who were victims of child labour. Presently this school has become residential school with 40 50 children. The children were taught by various means, learning includes singing, dancing,
playing, group discussion, slogans etc. The students were very active and have good grasping
power.
We took a visit to the Primary health centre. The PHC caters io about 50,000 population. The
PHC does not have its ambulance. The building of PHC was leaking. It consists of an AYUSH
doctor, a nurse and a technician and 2 pharmacists both for allopathy. The medicine stock
3
includes antibiotics, analgesics, anti-emetics and general medicine. All the vaccines were found
except BCG which was short of stock. Eye camps arc also conducted by the PHC Doctor and
staff .The diseases common among children arc diarrhoea and dermatitis.
VISIT TO
Monitoring
ROOVARI-Organization working on
health
Issues,
Community
The organization deals with issues related to sanitation, health, community monitoring etc. The
members of the organization got trained in Community monitoring in NRHM. They started
working in three phases, 1 taluka -15 villages and 3 PHC, 1 PHC and 5 villages and the last one
is 45 villages. In a district they have selected 3 talukas. Each taluka has 15 villages. In total they
have selected 9 PHC and 45 villages. The organization members attended 5 days district level
workshop, the training was given to DHO, MO, CDPO, NGO’s. At village level training was
given to gram panchayat members, village level health committee, anganwadi workers. For 3
days they went to villages.
Information gathering: The organization was involved in information gathering about the village
which includes resources available, health status mapping etc. The mapping includes village
mapping, Venn diagrams etc. The issues were identified and the voices were raised. After the
initiation of the organization there was improvement in working of Anganwadi workers. In 3-4
PHC staff also got improved. The status of 29 malnourished children also got improved.
VISIT TO VILLAGE: COMMUNITY VIOLENCE
Next day we visited to the village we discussed the atrocities faced by Dalits from the upper
class people. The issue was regarding the location of a community hall. It was situated in the
space of Dalits without their consent. Dalits were taken out from their houses and beaten up.
Upper caste people threw stones on the dalit houses and women and children got injured. The
Dalits were not allowed to enter hotels,shops and was not allowed to use local transportation.
This incident gave insight of the discrimination still persisting in the society.
NO TOBACCO DAY CELEBRATION- BANGALORE MEDICAL COLLEGE
31sl May is celebrated as World No Tobacco day. The function of No Tobacco day was organised
at Bangalore Medical College by Institute of Public Health and Bangalore Medical CollegeDistrict Tobacco cell. The function was chaired by the Director of Health Department overseeing
tobacco issues and a film director. The Institute of Public Health released the fact sheets on
tobacco consumption based on a study on school children. Painting competition on tobacco
related harmful effects was held for school children. The Director of the Health department
summed up the function by a speech on the necessity to ban tobacco and its harmful effects. The
visit to No tobacco day celebration gave me the insight of the existing tobacco addiction among
school students. The results of the research studies done by IIPH , Bangalore gave me an idea of
the existing tobacco addiction among school students.
VISIT TO MILANA
In order to have an idea about the H1V/AIDS issue and the social aspects related to the dreadful
disease I visited to an organization called MILANA The organization works for the HIV
afflicted people. I interviewed 4 women who was suffering from the dreadful disease AIDS.
They shared the hardships and stigma they faced as a result of this disease. They were socially
outcaste from the home as well as the community They met the head of the MILANA
organization from whom they got strength and started a self help group to make handicraft
items, bags and carpets and earn their livelihood through it.
4
VISIT TO WORKERS RESOURCE CENTRE, (WRC) for Garment workers
1 visited to WRC office with my mentor where 1 met Mr Gopinath we talked and discuss about
ES1M services. They explained the organogram of the ES1M services, ESI hospitals and
locations of PHC. I visited to workers resource centre office, WRC office to meet women and
know their perspectives. Among the 6 interviewed women, 4 were unsatisfied with the working
of ESI Dispensaries functioning. They complained of unavailability of the doctors, short OPD
timings and unavailability of the diagnostic services.
Along with 2 of my intern-friends, I gave oral health education to children of garment women
workers- demonstrated techniques of brushing, oral hygiene, general health and hygiene. The
students actively participated in the sessions.
STUDY OF THE STATUS AND FUNCTION OF ESI DISPENSARY
The Employees’ State Insurance Act,1948 (ESI Act) envisaged an integrated need based social
insurance scheme that would protect the interest of workers in contingencies such as sickness,
maternity, temporary or permanent physical disablement, death due to employment injury resulting
in loss of wages or earning capacity. The Act also guarantees reasonably good medical care to
workers and their immediate dependants. The Act covers all employees -manual, clerical,
supervisory and technical getting up to Rs.6500/- per month. The benefit under the ESI Scheme
included Medical benefit, sickness benefit, Maternity benefit disablement benefit dependants’
benefit (DB), Funeral Expenses.
Presently, full medical care has been extended to about 7,73,000 Insured persons and about
40,00,000 of their family members, headed by the Director through a network of 9 ESI hospitals.1
Diagnostic Centre, 3 ESI Annex hospitals, 130 full time ESI dispensaries, 7 part time ESI
dispensaries and through Government Hospitals and Primary Health centers
ORGANIZATIONAL SET UP OF DEPARTMENT OF E.S.I.S.M. SERVICES
Director
Deputy Director
Assistant Director
II
ESI.H.Indirangar
6 disp
Dispensaries 17.
attached to Shahabad ESI
Hosp.Adm. MO
ESIH.Mysore
Disp. 15
Adm.MO
Administrative Officer
Accounts Officer
II
ESIH.. Man galore ESI H.Davanagerc ESI H.Hubli
Disp.9
Adm.MO
Disp. 9
Adm.MO
Disp.7
Adm. MO
ESI H Dandcli ESI Bangalore
Dispensaries 23 +
Disp.7
Adm.MO
Adm.MO
I took ESI scheme as a case study to understand the public health system in India. Before
beginning the study I met Mr Chander, Project Director of Sankalp project (HIV -AIDS
Awareness project in ESI dispensaries).There I talked about tobacco work in which he was
involved, the anti tobacco campaigns, advocacy and implementation of No tobacco act. I
interacted with the Medical Doctor and came to know the discrepancy in primary health services
that ought to be provided and actually provided at the dispensary. The meet with the doctor &
other staff of the dispensary inspired me to study ESI medical services in depth.
ESI scheme and medical services
Then 1 visited the women Resource Centre (WRC) office to interview women and to understand
their perspectives regarding ESIM services. I interacted with the ESI Director at the ESI
Hospital, Rajajinagar to seek permission to visit and study ESI dispensaries. I had to go three
times to director’s office to get the official letter of permission. I also observed the departments
and the facilities provided in the ESI hospital.. The questionnaire to survey the ESI dispensaries
was developed based on the information available on the role of ESI dispensaries. Specific
questions on infrastructure facilities were adapted from Indian Public Health standards (IPHS)
of NRHM for a Primary Health Centre. The Questionnaire included both open ended and closed
ended questions .The questions were organized in following sections i.e. Infrastructure
.Amenities .Equipment availability .Manpower .Drugs .Medical services. National health
program implementation and Reproductive and child health 1 visited 6 ESI dispensaries in
Kengeri, Mysore road, Hanumanth Nagar, Bomnahalli, Basvangudi and Rajajinagar Twenty
eight people from seven dispensaries including Insurance Medical officers, clerks, pharmacist,
staff nurse and 10 patients were interviewed for different sections of the questionnaire.
Salient findings of the study:
On an average the dispensaries caters for around 15,000 people and on an average 100 patients
were seen on daily basis. Four of the dispensaries were located in own premises and have
fencing all around. The plaster and floor was in good condition and the cleanliness was good in
rooms and toilets. In all the clinics board displaying timings was only available in local language
and English, however information on services and doctors availability was lacking in all the
dispensaries. There was electric facility available in all the dispensaries but no standby facility
was available. The telephone facility was available but computer facility was lacking. The
ambulance is called occasionally only in the case of emergency cases according to the clerks.
However they do not have any record when the ambulance was last called and patients have to
manage on their own even in the case of emergencies. There was a separate registration counter
at the main entrance in all the dispensaries. There was a separate pharmacy for drug dispensing
and drug storage. There were separate utilities for male and female except in Hanumanth Nagar
dispensary were no toilet facility were available. On an average there were four OPD cubicles.
There was no separate examination room and the examination was done in OPD only. There
were rooms earmarked for office, injection and store room.
The equipment available included examination table foot step .saline stand, oxygen trolley,
weighing machine, sphygmomanometer, thermometer refrigerator , iron bed , dressing tray and
trolley, attendant stool, almirah, waiting bench, rack, autoclave for sterilizing instruments.
However arm board, wheel chair, stretcher on trolley, height measuring stand .instrument cabinet
.instrument tray instrument trolley, medical cabinet, swab rack were lacking in all the
dispensaries. The drugs included only general analgesics and antibiotics, ointments and drops.
Emergency drugs like adrenaline, epinephrine was available only in Bommanahalli dispensary.
The medical services available in dispensaries were restricted to examination and treatment of
the common ailments. In case of injury and wounds primary management like dressing and TT
is done. In case of fracture dressing and splinting is done. Primary management of
gynaecological disorders like medication and check up is done. Complicated patients are
referred to ESI Hospitals. Health education is done on HIV by Sankalp project person. No
vaccines were available in the dispensaries as there was no vaccine storage facility available and
no vaccination was done.,.
The common occupational related disease which doctors came across included Bronchial
asthma, allergic reactions and Dermatitis. For the diagnosis of pregnancy, tests for Haemoglobin,
Urine and albumin sugar, VDRLand HIV, Antenatal examination and postnatal review, women
6
are. referred to ESI Hospital. Iron and folic acid supplementation and Inj. TT was done in ESI
dispensaries .For various health programs the patient were referred to ESI Hospital as the
diagnostic facility was lacking in the dispensaries. Family planning counselling includes usage
of oral contraceptives and barriers methods. Vitamin A supplementation was done. However
growth monitoring and Immunization was not done. Thus the dispensaries were mainly
concerned with only primary management of the common diseases and referral As per the ESI
act and norms mentioned for ESI dispensaries, only referral and only few drugs like general
antibiotics, analgesics were available. Implementation of National Health Program is done in the
ESI hospital (like referral of patient suspected for tuberculosis are referred to DOTS centre).
Health education is done by Sankalp project people and is restricted to HIV only. There was a
gap in the ESI norms and the services provided the gap includes the services provided.
TOBACCO CESSATION CLINIC
Being a dental surgeon, I was also interested in tobacco cessation methods and functioning of
the tobacco cessation clinic which includes counselling, behavioural change and medication
therapy. WHO have established 12 tobacco cessation centers and NIMH ANS is the one in south
India. Tobacco cessation clinic at NIMHANS is a WHO collaborating centre which gives
counselling and motivates tobacco addicts to quit tobacco. Patients are referred by psychiatrist
and others come by their own will to quit tobacco. The therapies include counselling, motivation
and medical therapy .Patients are given education regarding the harmful effects of tobacco, its
effects on different organs and the whole system. The addictive nature of tobacco is also
explained to patients, and patients are wanted and prepared to face the withdrawal symptoms
associated with quitting tobacco. The carbon monoxide content of the breath is measured and the
patients are warned against the level which is harmful for the health. Various behaviours
associated with tobacco smoking like the timing of greatest craving, substance abuse and socio
economic condition is all together taken into account. The counselling is given by counsellors
who are graduates in social work and have undertaken some sort of training in counselling and
psychiatry. The medical component like the Nicotine replacement therapies and medication is
taken care by the Medical doctors.
1 have leamt the various tobacco cessation techniques, the behavior counseling and various
therapies for tobacco cessation, the withdrawal symptoms associated with tobacco quitting,
various factors associated with tobacco use and the compliance of patients with the cessation
techniques.
LOOKING INWARD
In the beginning, I learnt about health, Health care and Health services. Primary Health Care and
the services provided. In literature studies I read about the ESI health system, various benefits,
the organogram of the ESI Medical services. Besides it, I read about the tobacco cessation
methods, the ‘No Tobacco Act’ and the National Tobacco Control Programme.
The Employee medical services was an entirely new area of study for me but it interested me
and I got good hand on experience of one aspect of the public health system in India.
Personally, I have leamt many things. I am able to critically analyze the loopholes in existing
public health system. In taking permission from the ESI Director I came across the working of
government machinery. This was a challenge as the Deputy Director interviewed me and asked
several questions about my studies and my educational background. However the Director was
cooperative and gave permission but asked to submit the report before publishing anywhere. By
visiting different places and meeting workers of all level, 1 have got good exposure of the
perspective of the bureaucracy, the employees and the community.
7
My Observation skills have improved and 1 am able to understand and analyze the situation in a
better way. In the tobacco cessation clinic I learnt about behavioral aspect of tobacco
consumption and cessation, other habits associated with it and associated withdrawal symptoms
(the reason why people failed to quit the tobacco).
LOOKING OUTWARD
The CHLP gave me a multidimensional perspective towards pubic health which includes the
existing public health system analysis, primary health care, social and gender aspects, mental
health etc. This orientation helped me to understand holistic concept of health. From the field
visits I got acquainted with the ground realities and the community perspective. After
completing the internship I did few studies in Rajasthan as part of my MPH curriculum and
implemented few concepts like analysis of existing health system ,the evaluation of PHC on
Indian Public Health System norms, the research methodology and questionnaire designing . The
program helped me to understand the grass route level realities which will further help me in my
career.
FEEDBACK ABOUT CHLP PROGRAM
Although 1 was a flexible intern for 2 months from 16-6-2008 to 26-07-2009 I gained a lot. I
leamt various concepts of health and the determinants of health .The initial sessions helped me
to understand health as a holistic concept which includes mental, gender, social, environmental
and globalization related issues. The practical way of learning in gender issues and mental health
gave a long lasting impression. The way of teaching and delivering lectures was very' practical
and simple. I am sure this hand on experience will help me a lot in my career and future work.
The visits to organization like MILANA and meeting the HIV afflicted people gave me insight
of the prevailing discrimination and taboos associated with the disease. The visits to Raichur
was a eye opener for me as I saw the atrocities faced by the Dalits. The field visits gave me an
idea of the existing public health system, the loopholes and functioning of the government
machinery. The program helped me to understand public health in a pragmatic sense.
8
ANNEXUREI
Questionnaire -Evaluation of ESI dispensaries
PROFORMA FOR FACILITY SURVEY FOR ESI DISPENSARY
Date of Data Collection
:
Location Name of ESI Dispensary:
Timing of ESI Dispensary
:
Split hour Dispensary / Continuous working hour's
Insured persons covered (in numbers)
Number of OP Patients seen
:
INFRASTRUCTURE
Building
1.
Where is the dispensary located :
2.
Area of the building (Total area in Sq. mts.) :
3.
4.
Compound Wall / Fencing
Is boundary wall with gate existing?
1 .Own 2.Rented Premises 3.Other govt, building 4.Other
:
1.All around 2.Partial 3.None
5. Condition of plaster on walls: 1 .Well plastered with plaster intact every where 2.Plaster
coming off in some places 3.Plaster coming off in many places or no plaster
6. Condition of floor: 1 .Floor in good condition 2.Floor coming off in some places 3.Floor
coming off in many places or no proper flooring
7. How is the cleanliness?
Good
Fair
Poor
Remarks
OPD
Rooms
Toilets
Premises (compound)
8. Are any of the following close to the Dispensary?
1 .Yes
2,No
Garbage dump
Stagnant pool
Pollution from industry
LOCATION
1.
2.
3.
How many residential areas are covered by the dispensary?
Distance of Dispensary' (in Kms.) from the Diagnostic centre
Distance of Dispensary (in Kms.) from ESI hospital
9
AMENITIES
I.
Electricity
1. Is there electric line in all parts of the Dispensary?
1. In all parts 2.1n some parts 3.None
2.
Regular Power Supply: 1.Continuous Power Supply 2.Occasional power failure 3.Power cuts
3.
What is the stand by facility (generator) available during power supply?
II.
Communication facilities
in summer only 4.Regular power cuts 5.No power supply
1. Telephone
l.Yes2.No
2. Personal Computer l.Yes 2.No
III.
Vehicles
On an average how many times do you call for ambulance in a month?
When Ambulance was last called?
IV.
Facilities Available
l.Yes
2No
1.Rooms and Utilities
2.Prominent display boards regarding service availability in local language
3. Registration counters
4. Pharmacy for drug dispensing and drug storage
5. Separate public utilities for males and females
6. Suggestion / complaint box
7. OPD rooms / cubicles (Give numbers)
8. Adequate no. of windows in OPD room for light and air in each room
9 .Emergency Room / Casually
10. Examination room
11. Office room
12. Injection room
13. Store room
14.0thers
10
V.Equipment available
Yes
No
Remarks
1. Examination Tabic
2. Footstep
3. Ann board
4. Saline stand
5. Wheel chair
6. Stretcher on trolley
7. Oxygen trolley
8. Oxygen cylinder .Expiry date
9. Height measuring stand
10.Weighing machine
11 .Syphygnomanometer
12.Thermometer
13.Refrigerator
14.Iron bed
15. Dressing trolley
16.Dressing tray
17. Instrument cabinet
18. Instrument tray
19. Instrument trolley
20. Attendant stool
21. Almirah
22. Swab rack
23. Waiting bench for patients
24. Medicine cabinet
25. Rack
26. Dressing tray
27. Others
MANPOWER AVAILABILITY AT DISPENSARY
M/F Sanctioned
Present
On leave
Vacant
Remarks
Medical Officer
Pharmacist
Nurse
Clerks
Laboratory Technician
Administrator assistant
Helpers
Any other
DRUGS AVAILABLE
1.
Analgesics
2.
Anlibiotics
3.
Anti emetics
4.
Ointments and drops,
5.
Others
_
_____________________________________
_________________________________________________________
______________________________________________________
II
SERVICES PROVIDED
1.
What are your roles as a medical officer?
2.
What are the services provided ?
3.
What kind of primary management of wounds done at the Dispensary?
4.
Is the primary management of fracture done at the Dispensary? What is done?
5.
What minor surgeries are done at the Dispensary?
6.
Is the primary management of cases of poisoning / snake, insect or scorpion bite done at the
Dispensary?
Is the primary management of bums done at dispensary? What is done?
7.
8.
Is the treatment for gynaecological disorders like leucorrhoca, menstrual disorders available at the
dispensary?
_ _______________________________________________________
9.
Other functions and services performed
Is health education done in the dispensary? Who does it?
10.
Laboratory:
I.
2.
3.
Laboratory 1.Yes 2.No
Are adequate equipment and chemicals available? 1. Yes 2,No
Is laboratory maintained in orderly manner? l.Ycs 2.No
11.
Antenatal care
ESI Dispensary
Service
Diagnostic
centre
ESI Hospital
1. Diagnosis of pregnancy
2. Hemoglobin
3. Urine Albumin /Sugar
4. VDRL
5. HIV
6 Blood group typing
7. Antenatal-examination
8. Postnatal review
9. IFA
10. Inj.TT
Number of antenatal mothers registered in the time period April 08 -March 09 ?
National Health Program Implementation
Programmes
Diagnosis
Initate Rx
Monitor
Rx
Referral (Reasons)
RNTCP
NMCP
NA CP
12
National
filarial Control
programme
National
tobacco
Control
programme
National Iodine
Control
programme
REPRODUCTIVE AND CHILD HEALTH
Program
Yes
No
Remarks
Antenatal
Family planning
Growth monitoring
Vit.A
supplementation
Immunization
REIMBURSEMENT
What is the method of reimbursement for purchase of drugs not available in the dispensary?
13
PATIENTS PROFORMA
ACCESIBILITY
What arc the timings when dispensary is open?
Is the doctor available during the dispensary working hours?
What services have you come to he dispensary ?
What services do you get from the dispensary?
What services do you expect from the dispensary?
1.
2.
3.
QUALITY
I.
What is the perception of the patient towards quality of service, if possible narrate any
instance
2.
Do you face any incidence of any sexual advances? Oral or physical abuse, sexual harassment by the doctors or any other
paramedical?
3.
How is the behavior of the ESI Dispensary doctor, nurse and staff with the patient?
Courteous
Casual/indifferent
Insulting / derogatory
4.
Any fees for service is charged from you? (Yes I No). If yes, specify.
5.
Do you have to give extra money for any of the service provided? If yes,
Specify.
6.
Is a receipt always given for the money charged at the Dispensary? (Yes / No)
Confidentiality
Are woman patients interviewed in an environment that ensures privacy and dignity? (Yes / No)
Are examinations on woman patients conducted in presence of a woman attendant, and procedures conducted under conditions
that ensure privacy? (Yes / No)
Referral
How the patient are referred and transported if the services are lacking in dispensary?
Have you ever avail ambulance services?
Do you gel certificate and benefits claim on time? What arc the difficulties faced?
14
ANNEXURE II
A
REPORT
ON
STUDY
OF HEALTH SERVICES AT THE ESI
DISPENSARIES
AS A PART OF COMMUNITY HEALTH LEARNING
PROGRAMME
CHLP-2009
BY
Divya Persai
15
INTRODUCTION
An Insurance is a promise of compensation for specific potential future losses in exchange for a
periodic payment. Insurance is designed to protect the financial and medical well-being of an
individual, company or other entity in the case of unexpected loss.
The Employees’ State Insurance Act, 1948 (ESI Act) envisaged an integrated need based social
insurance scheme that would protect the interest of workers in contingencies such as sickness,
maternity, temporary or permanent physical disablement, death due to employment injury
resulting in loss of wages or earning capacity. The Act also guarantees reasonably good medical
care to workers and their immediate dependants. The Act covers all employees - manual.
clerical, supervisory and technical getting up to Rs.6500/- per month. The benefit under the ESI
Scheme included Medical Benefit, Sickness Benefit, Maternity Benefit Disablement Benefit
Dependants’ Benefit (DB) Funeral Expenses.
Following the promulgation of the ESI Act the Central Govt, set up the Employment state
insurance corporation (ESIC)to administer the Scheme. The Employee’s State Insurance Scheme
of India provides a more comprehensive cover of social insurance at a lower rate of contribution
from the employees.The ESIC service delivery system is a single administration system and
provides comprehensive medical and cash benefits.
The Medical Services are rendered by the Department of Employees State Insurance Scheme
(Medical) Services (ESIS (M) Services) The Scheme started functioning from 27,h July 1958 at
Bangalore .Initially 12 ESI Dispensaries, 100 bedded ESI Hospital catering more than 48,000
beneficiaries with the wage limit of Rs.400/-p.m were entitled for the sendees . Presently, full
medical care has been extended to about 7,73,000 Insured Persons and about 40,00,000 of their
family members, headed by the Director through a network of 9 ESI Hospitals, 1 Diagnostic
Centre, 3 ESI Annex Hospitals, 130 full time ESI Dispensaries, 7 Part time ESI Dispensaries
and through Government Hospitals and Primary Health Centers.
FUNCTIONS OF THE DISPENSARY
The dispensaries basically deal with:
•
•
•
•
•
•
Providing Primary Health Care to the Insured Persons and their family members, Out
patient treatment,
Free supply of Dings, Injections, Dressings etc.
Implementation of National Programmes.
Referral System to ESI Diagnostic Centre and ESI Hospital
Medical Reimbursement for the Drugs and Equipments, which are not available in the
ESI Hospitals.,
Medical Certification and Health Education.
OBJECTIVES
•
To understand the primary health services available at the dispensary'.
•
To understand the implementation of ESI Act and Medical services provided by it
through dispensaries.
•
To understand the basic infrastructure, facilities and functioning of the ESI
dispensaries.
16
methodology
The study permission was sought to visit 10 ESI dispensaries and staff by meeting the. The
questionnaire was developed based on the information available on the role of ESI Dispensaries
Specific questions on infrastructure facilities were adapted Indian Public Health standards
(IPHS) of NRHM for a Primary Health Centre. Questionnaire included both open ended and
closed ended questions .The questions were organized in following sections i.e. Infrastructure
2.Amenities 3.Equipment availability 4.Manpower 5. Drugs 6.Medical services 7.National
Health program Implementation and Reproductive and child health .Twenty eight people from
seven dispensaries including Insurance Medical officers, clerks, pharmacist, staff nurse and 10
patients were interviewed for different sections of the questionnaire.
I. ESI KENGERI DISPENSARY
The dispensary located in Kengeri is a continuous hours’ dispensary the timing is from 9-4pm.lt
caters for around 12,765 Insurance person (IP) card holders. The number of OP patients seen is
80 patients per day. It covers 30-40 villages and Kengeri , satellite town and Bidadi area.
INFRASTRUCTURE
The building is located in rented premises. There was no fencing around the building The plaster
and floor was in good condition and the cleanliness was fair in rooms and toilets. The main
board consist of timings only. There was a separate registration counter. There was a separate
pharmacy for drug dispensing and drug storage but adequate windows were lacking. There were
separate utilities for male and female. However toilets were located on different floor. There
were four OPD cubicles. There was no separate examination room and the examination was
done in OPD only. There was separate office, injection and store room.
AMENITITES
There was electric facility available in all the parts .However there was no standby facilities. The
telephone facility was available but computer facility was lacking. The ambulance is called
occasionally only in the case of emergency cases.
EQUIPMENTS AVAILABLE
The equipment available included examination table foot step , saline stand, oxygen trolley,
weighing machine, sphygmomanometer, thermometer refrigerator , iron bed , dressing tray and
trolley , attendant stool .almirah .waiting bench .rack, autoclave for sterilizing instruments and
nebulizer instrument was present .However arm board , wheel chair , stretcher on trolley .height
measuring stand .instrument cabinet .instrument tray .instrument trolley, medical cabinet were
lacking.
MANPOWER AVAILABILITY
The manpower included four sanctioned Medical officer three were female and one is male .All
four were present and the other was on duty at other dispensary(OOD).The other staff included
two pharmacist and two nurse while only one was present other was on OOD .One post of clerk
was sanctioned and one was present. The helpers included two people sanctioned post is also
two.
DRUGS AVAILABLE
The drugs included paracetomol Nimesulide, Diclofenac, Ibuprofen, The normal stock of
analgesics is around 30,0000 for 6 months. The antibiotics included Ampiciilin, Amoxicillin,
Cephalosporin, Norfloxacin, Doxycyclline and the normal stock is 15,000 tablets for 6 months.
Anti-emetics included - Metaclopromide, Domperidone, .Ointment and drops included
Soframycin, Neospirin, Pracethin, Diclogel, Clobitsol and Micanazole.
17
MEDICAL SERVICES
As per the insurance medical officer there roles included examination and treatment of the
patients, family planning, pregnancy counseling, HIV care. The services included Information
giving, referral, and treatment of all the common diseases. In case of injury and wounds primary
management like dressing and TT is done. In case of fracture dressing and splinting is done in
order to support the effected parts. Primary management of gynecological disorders like
medication and check up is done. Complicated patients are referred to ESI Hospitals.
Vaccination like polio is done on the National Polio day .Health education is done on family
planning , Immunization , HIV counseling .Doctors and Sankalp project person does it .No
vaccines are available In the dispensary and no vaccination is done.
The common occupational related disease which doctors come across included Bronchial
asthma, allergic reactions, gastric problems, Dermatitis. For the diagnosis of pregnancy,
Hemoglobin, Urine and albumin sugar, VDRL, HIV patients are referred to ESI Hospital.
Antenatal examination, postnatal review IFAand Inj.TT is done in ESI Dispensary.
NATIONAL HEALTH PROGRAM IMPLEMENTATION
For various health programs the patient are referred to ESI Hospital as the diagnostic facility is
lacking.
REPRODUCTIVE AND CHILD HEALTH
Family planning counseling including oral contraceptives and barriers are done .Vitamin
supplementation is done. On the other hand Growth monitoring and Immunization is not done.
II.
ESI DISPENSARY MYSORE ROAD
The dispensary located in Mysore road is a split hours’ dispensary the liming is from 9am-12pm
and 4-7 pm. It caters for around 25,000 card holders. The number of OP patients seen is 230
patients per day. The distance of dispensary from ESI Hospital is 8 km and from diagnostic
centre is 3-4 km. It covers 5-6 areas like old and new Guddahalli . Jaya Nagar, Azad Nagar, Pipe
line. Timber yard, Batranpura new extension, Bapuji nagar, Deepanjali Nagar.
The board displaying sendee availability consists of timings only. There was a separate
registration counter, there was a separate pharmacy for drug dispensing and drug storage .There
was separate utilities for male and female. There were four OPD cubicles. There was no separate
examination room and the examination was done in OPD only. There was separate office,
injection and store room. A separate leave certificate box was available.
INFRASTRUCTURE
The building is located in own premises. There was fencing all around the building .The plaster
and floor was in good condition and the cleanliness was good in rooms and toilets.
AMENITITES
There was electric facility available in all the parts .However there was no standby facilities. The
telephone facility was available but computer facility was lacking. The ambulance is called
occasionally only in the case of emergency cases.
EQUIPMENTS AVAILABLE
The equipment available included examination table foot step , saline stand, oxygen trolley,
weighing machine, sphygmomanometer, thermometer refrigerator, iron bed , dressing tray and
trolley, attendant stool, almirah, waiting bench, rack, autoclave for sterilizing instruments and
nebulizer instrument was present. However arm board, wheel chair, stretcher on trolley,height
measuring stand, instalment cabinet, instrument tray, instalment trolley, medical cabinet were
lacking.
18
MANPOWER AVAILABILITY
The manpower included four Medical officer three were female and one is male. All four were
present. The other staff included four pharmacist and three nurses three males and one female
pharmacist, one was on leave and three were present .all the three nurses were present .Two post
of clerk was sanctioned and both were present. The helpers included five people two male and
three females out of them only two were present one was on duty in another dispensary and the
other one was suspended.
DRUGS AVAILABLE
The drugs included analgesics like Paracetomol, Diclofenac, Diclo-SR.The antibiotics included
Ampiciilin 500 mg, Amoxicillin mg, Cephalosporin 500 mg, Ofloxacin 200mg, Roxid 150
mg,Erythromycin 250 ing.Anti-emetics included - Metaclopromide, Domperidone .Ointment
included Soframycin, Povidone, Metrogyl .Clotrimaxazole.Other drugs included Allerid 25mg ,
Lipril 5 mg , Ecospirin and Livincide.
MEDICAL SERVICES
As per the insurance medical officer there roles included providing healthcare which includes
examination and treatment of the patients. The services included Information giving, referral,
and treatment of all the common diseases. In case of injury and wounds primary management
like sterilized dressing and TT is done. In case of fracture dressing and splinting is done and
patients are referred to nearby hospital. No minor surgeries are done in dispensary. No primary
management of insect or snake bit is done as anti-venom sera was not available in dispensary.
For management of gynecological disorders patients are referred to ESI Hospital. Vaccination
like polio is done on the National Polio day .HIV counseling is done by Sankalp project person
does it doctors do not do it .No vaccines were available in the dispensary and no vaccination is
done.
The common occupational related disease which doctors come across included Bronchial
asthma, allergic reactions, Dermatitis. For the diagnosis of pregnancy. Hemoglobin, Urine and
albumin sugar, VDRL, HIV, Antenatal examination, postnatal review patients are referred to
Diagnostic centre. Inj.TT is done in ESI Dispensary. No laboratory facility was available in
dispensary'.
According to Sankalp project counselor 20-15 patients are counseled by her in a day. Counseling
is given on HIV, Family planning, Antenatal care, Child health ,Tuberculosis and STD diseas.
The counselor have undertaken 5 days training in Reproductive and child health.
NATIONAL HEALTH PROGRAM IMPLEMENTATION
For various health programs the patient are referred to ESI Hospital as the diagnostic facility is
lacking .
REPRODUCTIVE AND CHILD HEALTH
Family planning counseling including oral contraceptives and barriers methods are done Vitamin
A supplementation is done. On the other hand Growth monitoring and Immunization is not done
and patients are referred to ESI Hospital.
III.
ESI DISPENSARY HANUMANTH NAGAR
The dispensary located in Hanumanth Nagar is a split hours’ dispensary the timing is from 9-12
and 4-7 pm. It caters for around 2094 Insurance person (IP). The number of OP patients seen is
30 patients per day. The distance of dispensary from ESI Hospital is 15 km and from diagnostic
centre is 4 km. It covers 5-6 areas like Hanumanth Nagar, Howlaharli, Girinagar J and II Phase
19
INFRASTRUCTURE
The building is located in rented premises. There were five rooms separated by plastic partition.
There was no fencing around the building. The plaster and floor was in good condition and the
cleanliness was good in rooms. There was no toilet facility available in the dispensary.
AMENIT1TES
There was electric facility available in all the parts .However there was no standby facility. The
telephone facility was available but computer facility was lacking. The ambulance is called
occasionally only in the case of emergency cases
ROOM AND UTILITIES
The board displaying service availability consists of timings only. There was no separate room
for pharmacy and registration both is shared in a single room. There was no toilet facility
available. There were two OPD cubicles. Adequate no. of windows was lacking in the
dispensary.There was no separate emergency and examination room and the examination was
done in OPD only. There was separate injection and store room.
EQUIPMENTS AVAILABLE
The equipment available included examination table, saline stand, weighing machine,
sphygmomanometer, thermometer refrigerator , iron bed , dressing tray and trolley , attendant
stool .almirah ,waiting bench ,rack. However arm board , foot step ,wheel chair oxygen trolley
and cylinder, wheel chair , stretcher on trolley ,height measuring stand .instrument cabinet,
instrument tray .instrument trolley, swab rack medical cabinet were lacking.
MANPOWER AVAILABILITY
The manpower included two Medical officer both are female. Only one was present, one is
vacant as the doctor went for higher studies The other staff included two pharmacist both were
present and one nurse who was present .One post of clerk was sanctioned was present. The
helpers included three people two male and one female out of them only two were present one
was on treasury duty.
DRUGS AVAILABLE
The drugs included analgesics like Paracetomol, Ibuprofen, Seropeptidase.The antibiotics
included Amoxicillin 500 mg, Cephalosporin 500 mg, Ciprofloxacin 500mg.Anti-emetics
included - Metaclopromide, Domperidone.Ointment included Soframycin, Metrogyl,
Clotrimaxazole.
MEDICAL SERVICES
As per the insurance medical officer their roles included providing healthcare which includes
examination and treatment of the patients, Maintenance of doctor -patient relationship .referral
to higher centres. The services included OP, referral, and treatment of all the common diseases.
In case of injury and wounds primary management like sterilized dressing and TT is done. In
case of fracture dressing and splinting is done and patients are referred to nearby hospital.
Drainage of abscess and suturing of clean cut wound is done. No primary management of insect
or snake bit is done as anti-venom sera were not available in dispensary. For the management of
bums antiseptics, antibiotics and dressing are done .Checkup and pervaginal examination is
done in case of gynecological disorders. No vaccines were available in the dispensary and no
vaccination is done. Health education is done by doctors on family planning ,HIV .Hygiene and
alcohol related problems.
The common occupational related disease which doctors come across included Bronchial
asthma, allergic reactions, Dermatitis. For the diagnosis of pregnancy, Hemoglobin, Urine and
albumin sugar, VDRL, HIV. Antenatal examination, postnatal review patients and Inj.TT is done
in ESI Dispensary. No laboratory facility was available in dispensary.
20
NATIONAL HEALTH PROGRAM IMPLEMENTATION
For various health programs the patient are referred to ESI Hospital as the diagnostic facility is
lacking .For suspected tuberculosis cases patients are referred to nearby DOTS centre.
REPRODUCTIVE AND CHILD HEALTH
Family planning counseling including oral contraceptives and barriers methods are done Vitamin
A supplementation is done. On the other hand Growth monitoring and Immunization is not done
and patients are referred to ESI Hospital.
ESI
IV.
DISPENSARY BOMANAHALLI
The dispensary located Bomanahalli is a continuous hours’ dispensary the timing is from 7am -7
pm. It caters for around 24,500 Insurance person (IP). The number of OP patients seen is 150
patients per day. The distance of dispensary from ESI Hospital is 14 km and from diagnostic
centre is 16 km. It covers 5-6 areas like Bomanahalli, Jay Nagar ,T.T.Nagar, Benagatta road,
Cichandra, Ponachandra.
The board displaying service availability consists of timings only. There was a separate
registration counter and separate pharmacy for drug dispensing and drug storage. There were
separate utilities for males and females. There were five OPD cubicles. There was no separate
examination room and the examination was done in OPD only. There was separate office,
injection and store room. Adequate number of windows and ventilation was present in the
rooms.
INFRASTRUCTURE
The building is located in rented premises. There were ten rooms .There was no fencing around
the building. The plaster and floor was in good condition and the cleanliness was good in rooms
and toilets.
AMENITITES
There was electric facility available in all the parts .However there was no standby facilities. The
telephone facility was available but computer facility was lacking. The ambulance is called
occasionally only in the case of emergency cases
EQUIPMENTS AVAILABLE
The equipment available included examination table, saline stand, weighing machine,
sphygmomanometer, thermometer refrigerator , iron bed , dressing tray and trolley , attendant
stool ,ahnirah ,waiting bench , instrument tray and trolley, oxygen trolley and cylinder, foot step
,rack and dressing tray. However arm board , ,wheel chair oxygen trolley and cylinder, wheel
chair , stretcher on trolley .height measuring stand .instrument cabinet , swab rack medical
cabinet were lacking.
MANPOWER AVAILABILITY
The manpower included seven Medical officer five are female and two were male. The
sanctioned post were seven and seven doctors were posted. The other staff included four
sanctioned post of pharmacist out of which three was present and one was vacant Two post of
clerk was sanctioned and both were present. The helpers included four people three male and
one female all the four were present.
DRUGS AVAILABLE
The drugs included analgesics like Paracetomol, Diclofenac,Imol.lndomethacin.The antibiotics
included Amoxicillin mg, Cephalosporin 500 mg, Ciprofloxacin 500mg.Anti-emetics included Metaclopromide, Domperidone.Ointment included Soframycin, Metrogyl .Clotrimaxazole.
Other included zytee and povidone mouth wash.
21
MEDICAL SERVICES
As per the insurance medical officer their roles included providing healthcare which includes
examination and treatment of the patients, referral to higher centres. The services included OP.
referral and treatment of all the common diseases. In case of injury and wounds primary'
management like sterilized dressing and TT is done. In case of fracture dressing and splinting is
done and patients are referred to nearby hospital. No minor surgical procedures are done .No
primary' management of insect or snake bite is done as anti-venom sera was not available in
dispensary'. For the management of bums antiseptics, antibiotics and dressing is done. For the
management of gynaecological disorders examination is done and medication is given. No
vaccines were available In the dispensary and no vaccination is done. Health education is done
by doctors on family planning, HIV, Hygiene and alcohol related problems.
The common occupational related disease which doctors come across included Bronchial
asthma, allergic reactions. Dermatitis, frostbite, occupational injury . For the diagnosis of
pregnancy. Hemoglobin, Urine and albumin sugar, VDRL, HIV. Antenatal examination,
postnatal review patients and Inj.TT is given in ESI Dispensary. No laboratory facility was
available in dispensary.
NATIONAL HEALTH PROGRAM IMPLEMENTATION
For various health programs the patient are referred to ESI Hospital as the diagnostic facility is
lacking .For suspected tuberculosis cases patients are referred to nearby DOTS centre. Polio
Immunization is done on National Polio day.
REPRODUCTIVE AND CHILD HEALTH
Family planning counseling including oral contraceptives and barriers methods are done For
Vitamin A supplementation patients are referred to nearby PHC. On the other hand Growth
monitoring and Immunization is not done and patients are referred to ESI Hospital.
V.
ESI BASVANGUDI DISPENSARY
The dispensary located in Basvanguddi is a split hours’ dispensary the timing is from 9-12 am
and 4-7 pm. It caters for around 13,000 Insurance persons (IP). The number of OP patients seen
is 120 patients per day. The distance of dispensary from ESI Hospital is 8 km and the diagnostic
centre is in the building itself. It covers Basvanguddi , Hanumanth Nagar, Mysore road,
Jaynagar, Kanakpura, Subrayapura.
INFRASTRUCTURE
The building is located in own premises. There was fencing all around the building .The plaster
and floor was in good condition and the cleanliness was good in rooms and toilets.
The board displaying service availability consists of timings only. There were 11 rooms in the
building there was a separate registration counter and room. There was a separate pharmacy for
drug dispensing and drug storage with adequate windows. There were separate utilities for male
and female. There were five OPD cubicles. There was no separate examination room and the
examination was done in OPD only. Separate office, injection and store room was present.
AMENITITES
There was electric facility available in all the parts .However there was no standby facilities. The
telephone facility was available but computer facility was lacking. The ambulance is called
occasionally only in the case of emergency cases.
EQUIPMENTS AVAILABLE
The equipment available included examination table foot step , saline stand, oxygen trolley,
weighing machine, sphygmomanometer, thermometer refrigerator , iron bed , dressing tray and
22
trolley, attendant stool, almirah, waiting bench, rack, autoclave for sterilizing instruments
instinment tray .instrument trolley However arm board , wheel chair , stretcher on trolley .height
measuring stand .instrument cabinet , medical cabinet were lacking. The oxygen trolley and
cylinder was not in working condition.
MANPOWER AVAILABILITY
The manpower included five sanctioned Medical officer .Out of which two were present two are
vacant .another doctor was on leave .The other staff included four sanctioned pharmacist among
them three were present and one was on leave and three sanctioned nurse out of which two was
present and one was on leave. Three post of clerk was sanctioned and all were present. The
helpers included seven sanctioned post four females and two males one post was vacant.
DRUGS AVAILABLE
The drugs included paracetomol, Pyrixel, Imol, Piroxicam. The antibiotics included Amoxicillin,
Cephalosporin, Doxycyclline and erythromycin.Anti-emetics included - Metaclopromide,
Domperidone, .Ointment and drops included Soframycin. Neospirin, Pracethin, Diclogel,
Clobitsol and Micanazole,Bitavin , Micradic Povidone Iodine and Cinus drops,
MEDICAL SERVICES
As per the insurance medical officer there roles included OPD services and referral. The services
included Information giving, referral, and treatment of all the common diseases. In case of injury
and wounds primary management like dressing and TT is done. In case of fracture patients are
referred to ESI hospital. Primary management of gynecological disorders like medication and
check up is done. Complicated cases are referred to ESI Hospitals. Vaccination like polio is done
on the National Polio day .Health education is done relevant to the disease and the patients
interests. No vaccines are available In the dispensary and no vaccination is done.
The common occupational related disease which doctors come across included Bronchial
asthma, allergic reactions, Dermatitis and injuries. For the diagnosis of pregnancy, Hemoglobin,
Urine and albumin sugar, VDRL, HIV patients are referred to ESI Hospital. Antenatal
examination, postnatal review IFAand Inj.TT is done in ESI Dispensary.
NATIONAL HEALTH PROGRAM IMPLEMENTATION
For various health programs the patient are referred to ESI Hospital as the diagnostic facility is
lacking .
REPRODUCTIVE AND CHILD HEALTH
Family planning counseling including oral contraceptives and barriers methods are done
Vitamin A supplementation is done. On the other hand Growth monitoring and Immunization is
not done.
VI.
ESI RAJAJINAGAR DISPENSARY
The dispensary located in Rajajinagar 1SL block is a split hours’ dispensary the timing is from 912 pm and 4-7 pm. It caters for around 24534 Insurance persons (IP). The number of OP patients
seen is 120 patients per day. The distance of dispensary' from ESI Hospital is 2 km and from
diagnostic centre is 5km .It covers Mahalaxmi layout, Nandini layout, Gayatri nagar,
Subrmanyam nagar, Prakash Nagar, Milk colony.
INFRASTRUCTURE
The building is located in own premises. There was fencing around the building .The plaster and
floor was in good condition and the cleanliness was good in rooms and toilets.
23
AMENITITES
There was electric facility available in all the parts .In case of power cuts gas lights are
available. The telephone facility was available but computer facility was lacking. The ambulance
is called occasionally only in the case of emergency cases.
ROOM AND UTILITIES
The board displaying service availability consists of timings only. There was a separate
registration counters at the main entrance There was a separate pharmacy for drug dispensing
and drug storage There was separate utilities for male and female. There were four OPD
cubicles. There was no separate examination room and the examination was done in OPD only.
There was separate office, injection and store room.
EQUIPMENTS AVAILABLE
The equipment available included examination table foot step, saline stand, oxygen trolley,
weighing machine, sphygmomanometer, thermometer refrigerator, iron bed, dressing tray and
trolley, attendant stool, almirah, waiting bench ,rack, autoclave for sterilizing instruments.
However arm board, wheel chair, stretcher on trolley, height measuring stand, instrument cabinet
.instrument tray, instrument trolley, medical cabinet ,swab rack were lacking.
MANPOWER AVAILABILITY
The manpower included 4 Medical officer 3 were female and one is male .All four were present
.The other staff included four sanctioned post of pharmacist,3 males and one female. One
pharmacist was on leave. Three nurse were sanctioned and all the three were present. Three
post of clerk was sanctioned two were present and was on leave. The helpers included 3 people
sanctioned post is also three and all the thee were present.
DRUGS AVAILABLE
The drugs included paracetomol Nimesulide, Diclofenac, Ibuprofen.The antibiotics included
Ampiciilin, Amoxicillin, Cephalosporin, Norfloxacin, Doxycyclline and the normal Anti-emetics
included - Omez, Domperidone, .Ointment and drops included Soframycin, Neospirin.
Betnovate, Clobitsol and Micanazole.
MEDICAL SERVICES
As per the insurance medical officer there roles included examination and treatment of the
patients. The services included Information giving, referral, and treatment of all the common
diseases. In case of injury and wounds primary management like dressing and TT is done. In
case of fracture dressing and splinting is done in order to support the effected parts. Primary
management of gynecological disorders like medication and check up is done. Complicated
patients are referred to ESI Hospitals. Health education is done on family planning ,
Immunization, HIV.Doctors and Sankalp project person does it No vaccines are available In the
dispensary and no vaccination is done.
The common occupational related disease which doctors come across included Bronchial
asthma, allergic reactions, gastric problems, Dermatitis. For the diagnosis of pregnancy.
Hemoglobin, Urine and albumin sugar, VDRL, HIV patients Antenatal examination, postnatal
review are referred to ESI Hospital. IFAand Inj.TT is done in ESI Dispensary.
NATIONAL HEALTH PROGRAM IMPLEMENTATION
For various health programs the patient are referred to ESI Hospital as the diagnostic facility is lacking.
REPRODUCTIVE AND CHILD HEALTH
Family planning counseling including oral contraceptives and barriers arc done .Vitamin
supplementation is done. On the other hand Growth monitoring and Immunization is not done.
24
MEETING WITH THE ESIM DIRECTOR
The ESI dispensary is under the Ministry of labor and under the directorate of ESIM services.
The director of ESI M services is Dr Rahimunasa .On asking the director about the existing gaps
in the ESI system no satisfactory answers came out. On asking about the unavailability of the
doctors in the duty hours the director replied that some of the staff including doctors are shifted
to other dispensaries due to work overload termed as ODD Duty. On asking about the
unavailability of the ambulance the director replied that its called on the emergency basis
.However the dispensaries did not had any record of any ambulance call in for approximately
one year and (he staff did not remember when last time it had been called. On asking about the
vacany of the staff in certain dispensaries the director replied it will soon be filled and
advertisement will be issued in local news paper for the same. On Questioning about the
sendees provided director replied that the maximum services are provided by the ESI hospital
and dispensaries are entitled for primary services and ailment.
SUMMARY
Out of 6 ESI Dispensaries studied four were split hours with timings from 9am -13 pm and 4pm
to 7 pm .the rest three were continuous hours dispensaries with timings from 7am-7pm.On an
average the dispensaries caters for around 15,000 people and on an average 100 patients were
seen on daily basis. Four of the dispensaries were located in own remises and have fencing all
around. The plaster and floor was in good condition and the cleanliness was good in rooms and
toilets. In all the clinics board displaying only timings was available in local language and
english, however information on services and doctors availability was lacking In all the
dispensaries, there was electric facility available in all the parts .In all the dispensaries except
no standby facility was available . The telephone facility was available but computer facility was
lacking. The ambulance is called occasionally only in the case of emergency cases as per the
clerks however they do not have any record when the ambulance was last and patients have to
manage on their own even in the case of emergencies. There was a separate registration counters
at the main entrance in all the dispensaries. There was a separate pharmacy for drug dispensing
and drug storage There was separate utilities for male and female except in Hanumanth Nagar
dispensary were no toilet facility were available. On an average there were four OPD cubicles .
There was no separate examination room and the examination was done in OPD only. There was
separate office , injection and store room. The equipment available included examination table
foot step , saline stand, oxygen trolley, weighing machine, sphygmomanometer, thermometer
refrigerator , iron bed , dressing tray and trolley , attendant stool .almirah .waiting bench .rack.
autoclave for sterilizing instruments .However arm board , wheel chair , stretcher on trolley
.height measuring stand .instrument cabinet .instrument tray .instrument trolley, medical cabinet
,swab rack were lacking in all the dispensaries. The drugs included only general analgesics like
paracetamol Nimesulide, Diclofenac, Ibuprofen.The antibiotics included Ampiciilin,
Amoxicillin, Cephalosporin, Norfloxacin, Doxycyclline and the normal Anti-emetics - Omez,
Domperidone, .Ointment and drops available included Soframycin, Neospirin, Betnovate ,
Clobitsol and Micanazole.However emergency drigs like adrenaline .epinephrine were available
only in bomnahalli dispensary.The medical services available in dispensaries were restricted to
examination and treatment of the common ailments. In case of injury and wounds primary
management like dressing and TT is done. In case of fracture dressing and splinting is
done.Primary management of gynecological disorders like medication and check up is done .
Complicated patients are referred to ESI Hospitals. Health education is done on HIV by Sankalp
project person . No vaccines are available In the dispensary and no vaccination is done, there
was no storage facility available for the common occupational related disease which doctors
come across included Bronchial asthma, allergic reactions and Dermatitis. For the diagnosis of
pregnancy, Hemoglobin, Urine and albumin sugar, VDRL, HIV, Antenatal examination,
postnatal review are referred to ESI Hospital. IFA and Inj.TT is done in ESI Dispensary. For
various health programs the patient are referred to ESI Hospital as the diagnostic facility is
25
lacking. Family planning counseling including oral contraceptives and barriers are done.
Vitamin A supplementation is done. On the other hand Growth monitoring and Immunization is
not done.
Thus the dispensaries were mainly concerned with only primary management of the common
diseases and referral .As per the ESI act and norms mentioned for ESI dispensaries only referral
and only few drags like general antibiotics, analgesics were available. There was no
Implementation of National Health Programmes at the dispensary' and patients are referred to
ESI hospital or DOTS centre for that. Health education is done by Sankalp project people and is
restricted to HIV only.
26
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Community Health Cell (Functional Unit of SQCHARA)
85/2, 1st Main, Maruthi Nabara, Madiwala,
Bengaluru
56OD68
Tel: +9 1 -80-2553 1 5 1 8/25525372
Email: chinternship@sochara.org
Website: www.sdghara.org
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