Job responsibilities Dr Pracheth R Levels Primary care

Job responsibilities Dr. Pracheth R.

Levels • Primary care level • Secondary care level • Tertiary care level ØReferral system

Primary health care definition • Essential health care • Universally accessible • Acceptable • Full participation • Cost: community-afford

Eight elements 1. 2. 3. 4. 5. 6. 7. 8. Education Promote: food supply, nutrition Adequate supply: safe water, sanitation MCH care+ family planning Immunization Prevent, control: locally endemic diseases Appropriate treatment Essential drugs

Principles

Principles** • Equitable distribution: üAccessible, equal üCities-rural • Community participation: üLocal community-success üVillage health guides, trained dais üInfluence: China

Continued…. • Inter-sectoral coordination: üAgriculture, food, communication üStrong political will üAvoid duplication

Continued…. • Appropriate technology: üScientifically sound, adaptable : local needs üSelf-reliance, affordable üLarge hospitals: block improvement • Starts with people themselves

Health For All • In 1977: by 2000 • Level: health-every person: socially, economically productive life • In 1981: global strategy by WHO • National strategy: üIMR, Life expectancy, death , birth rates üReduce NRR üWater

Millennium Development Goals • In 2000: 189 countries • Reduce poverty, hunger, gender inequality, education, clean water, environment • 3 -8 goals, 8 - 18 targets, 18 -48 indicators • Date: 1990 - 2015

Continued… • Goal 1: Eradicate poverty, hunger: 1/2 • Goal 4: Reduce child mortality: 2/3 • Goal 5: Improve maternal health: ¾ Target B: universal access: reproductive health • Goal 6: Combat HIV, malaria: ½ • Goal 7: Sustainable environment • Goal 8: Global partnership for development

Sustainable development goals • On September 25 th 2015 • Achieved by 2030 • There are 17 goals • 1: Reduce poverty • 2: Zero hunger • 3: Good health • 6: Clean water and sanitation

Primary health care in India • Placing health : people’s hands üVillage level üSub-centre üPHC üCHC

Village level • Village health guide: üHonorary üMostly women üPermanent residents, read write, acceptable, 2 -3 hours üWorking manual, simple medicines kit üTreat simple ailments üFrom 2002: stopped

Local dais

Local dais • Rural health scheme: train, improve knowledge • 30 working days, stipend • Training: PHC: 2 days , 4 days-health worker • Asepsis, hygiene • After training: completion, kit • One per village

Anganawadi Workers (AWW) • For 400 -800 • Training: health, nutrition, child care • Honorarium • Implement: ICDS

ASHA

Selection of ASHA • Resident • Married/widowed/divorced: 25 -45 years • Tenth class • Communication skills, leadership qualities • One/1000 population

Roles and responsibilities • Create awareness: health-sanitation, nutrition, , existing health services • Counsel women: birth preparedness, safe delivery, breast feeding • Mobilize people: health services • Escort pregnant women: health facility

Roles of responsibilities: ASHA • Medical care: diarrhoea, fever, first aid • Depot holder: ORS, IFA, OCP • Essential newborn care: common ailments • Inform: births, deaths in village

Female Health Worker= ANM=JHA • Maternal and Child Health • Family planning • MTP • Nutrition • Immunization • Dai training • Record keeping • Treat minor ailments

ANM in MCH • Register, antenatal care • Ensure: women: 4 antenatal visits • Identify high-risk cases • Refer abnormal cases • Conduct deliveries/supervise: dais • Refer: difficult deliveries

Continued…. . • Identify: beneficiaries-JSY • Make: at least 2 postnatal visits • Assess growth: infant • Essential newborn care • Immunization, breast feeding promotion • Treat childhood ailments

ANM in family planning • Utilize : eligible couple register-family planning programme • Distribute: OCP/conventional contraceptives • Follow up services: side-effects • Establish female depot holders-continuous supply • Identify, refer those: needing MTP

Registers maintained-ANM • Report vital events-health authorities • Register: pregnant, infants, women: 15 -49 years • Eligible couple, child register • Pre-natal, maternity, child care records • Records: contraceptive used, couples sterilized, IUD inserted.

ASHA+ ANM • Weekly /fortnightly meeting: discuss activities • Resource persons • Update eligible couple register • Motivate pregnant women: TT, IFA • Orient ASHA: OCPs • Danger signs: pregnancy

Health worker (male)/ MPW • Record keeping • NVBDCP: üMalaria üKala azar: fever 15 days, suspect : PHCs üJE üFilariasis: lymphoedema • Identify skin patches • RNTCP

Continued… • NBCP • RMNCH+A • Communicable diseases • Environmental sanitation • Health education • Record maintenance

Sub-centre

Sub-centre level • Every 5000, 3000: difficult areas • Link with grass root level • Female Health Worker: ANM/JHA • Male Health Worker: MPW • One health assistant (female): LHV, health assistant (male): supervize

Health assistant (Female)/LHV/SHA

Health assistant (Female)/LHV/SHA • Covers: 30, 000 population (20, 000: hilly) • Supervision, guidance • Supplies, equipment, maintenance: sub-centres • Records, reports: scrutiny • Train ASHAs/Dais • MCH clinics: Sub-centres, respond to calls from Dais

Continued… • Family welfare clinics • Inform: services-MTP • Identify: malnutrition cases • IFA, Vitamin A • Supervise immunization • Early diagnosis: ARI • Kala azar, JE, fliariasis: endemic- 10% houses verify • Help MO: school health services

Health assistant (male) • Malaria: supervise MHW, minimum 10% house check, supervise spray insecticides • Communicable disease: outbreak investigation • Leprosy: ensure proper treatment • TB: ensure complete treatment

Continued…. . • Environmental sanitation • Nutrition: identify, IFA, Vitamin A • Blindness: case referral • Conduct immunization : school going children

Primary Health Centres (PHCs) • Population: 30, 000; 20, 000 (difficult) • Functions: üMedical care, MCH üPrevention, control: endemic diseases üHealth education üWater+ sanitation üCollect, report vital statistics üNational Health Programmes üReferral, laboratory

Medical officer

Medical Officer • Captain: health team, morning: OPD, supervisor • Plan and implement immunization • Proper implementation: IMNCI • School visits • Training: ASHAs, AWWs, Dais • National Health Programmes: guidelines

Continued…. • Visit sub-centres: fixed days • Once a month: staff meeting • Team leadership: success

Community Health Centres (CHCs) • Population: 80, 000 to 1 lakh • 30 beds; specialists: surgery, medicine, OBG, paediatrics-X ray, lab facilities • New non-medical post: Community Health Officer • Refer: Nearest Medical College/State level hospital

First Referral Unit (FRUs) • Surgical interventions • New-born care • Blood storage facility: 24 hours

Services • 24 X 7 delivery • Emergency obstetric care • New-born care • Emergency care: sick children • Family planning • Safe abortion

Continued…. • Treat: STI/RTI • Blood storage • Essential laboratory • Referral (transport)

Indian Public Health Standards Why ? ? • Comprehensive health care • Acceptable standard • Sensitive: needs of people

Shortage • Health is not everything • But everything else is nothing without health • Shortfall of 12% for sub centers (existing 146, 026) • 16% of Primary Health Centers (PHCs) (existing 23, 236) • 50% Community Health Centers (CHCs) (existing 3346)

Continued…. • Peons double as medical staff at some PHCs • Some 24 X 7 PHCs only by name • AYUSH: Medical Officers • Compulsory rural service

Summary • Millennium Development Goals • Dais, AWW, ASHA • Female, male health workers • Female, male health assistants • Medical Officer

Questions (6 marks) 1. Define primary health care. Briefly explain the principles of the same (1+5) 2. Write about the staffing pattern and functioning of a Primary Health Centre (2+4). 3. What is a Community Health Centre? Describe how health care is delivered by a Community Health Centre (1+5). 4. What are the health-related Millennium Development Goals ? Critically evaluate India’s progress in achieving this Goals (1+5).

Questions (3 marks) 5. Write briefly about elements of Primary Health Care. 6. Functions of a Traditional Birth Attendant (Dai) 7. Role of an Anganawadi Worker in delivering health care 8. Duties of a Medical Officer of a PHC. 9. Job description of an ASHA. 10. Job description of a Health Worker Female

Questions (3 marks) 11. Job responsibilities of Male Health Worker 12. Functions of Female Health Assistant 13. Functions of Health Assistant Male

Questions (2 marks) 14. Staff pattern of a PHC 15. What is Health For all, 2000 ? 16. What are Sustainable Development Goals ? 17. Enlist the functions of a sub-centre 18. Critical determinants of a First-Referral Unit

Thank you