Health care services: Health care services PRESENTED BY: Mrs.krishnaveni Murugesh Rural Health Care System in India : Rural Health Care System in India Introduction:: Introduction: In 1977, the World Health Assembly gave the call of “Health For All by 2000 AD”. Primary Health Care was organized at Alma Ata, The capital of Kazakh Soviet Socialist Republic from 6-12 th September 1978. Thus Primary Health Care forms an integral part of the country’s health system and of the overall social and economic development of the community. PowerPoint Presentation: The health care infrastructure in rural areas has been developed as a three tier system Sub-Centre Primary Health Centre Community Health Centre Population Norms : Population Norms . Centre Plain Area Hilly/Tribal/Difficult Area Sub-Centre 5000 3000 Primary Health Centre 30,000 20,000 Community Health Centre 1,20,000 80,000 Sub-Centres (SCs) : Sub- Centres (SCs) The Sub-Centre is the most peripheral and first contact point between the primary health care system and the community. PowerPoint Presentation: Number of Sub Centres existing as on March 2011 increased from 146026 in 2005 to 148124 in 2011. There is significant increase in the number of Sub Centres in the States of Chhattisgarh, Haryana, Jammu & Kashmir, Karnataka, Maharashtra, Orissa, Punjab, Rajasthan, Tamil Nadu, Tripura and Uttarakhand . PowerPoint Presentation: The Sub- Centres are provided with basic drugs for minor ailments needed for taking care of essential health needs of men, women and children. PowerPoint Presentation: Existing STAFFING PATTERN STAFF FOR SUB - CENTRE: Number of Posts Health Worker (Female)/ANM 1 Additional Second ANM (on contract) 1 Health Worker (Male 1 Voluntary Worker (Paid @ Rs.100/- p.m. as honorarium) .. 1 Total (excluding contractual staff): 3 Introduction PHC : : Introduction PHC : The primary health centre, it is not new to India. The Bhore Committee in 1946 gave the concept of a Primary Health centre as a basic health unit, to provide, as close to the people as possible, an integrated curative and preventive health care to the rural population with emphasis on preventive and promotive aspects of health care. Introduction: : Introduction: It is the first level of contact of the individual, the family and the community with the national health system, bringing health care as close as possible to where people live and work. Primary Health Centres (PHCs : Primary Health Centres (PHCs PHC is the first contact point between village community and the Medical Officer. The PHCs were envisaged to provide an integrated curative and preventive health care to the rural population with emphasis on preventive and promotive aspects of health care. The PHCs are established and maintained by the State Governments under the Minimum Needs Programme (MNP)/ Basic Minimum Services (BMS) Programme . As per minimum requirement definition: definition Essential health care, made universally accessible to individuals and families in the community by means acceptable to them, through their fullest participation and at a cast, that community and country can afford. ( According to the Conference ) Criteria Pre Requisites: Criteria Pre Requisites The scope, the purpose and the mode of delivery of primary health care is different from country to country, the health problems of which differ from time to time and place to place. The Primary Health Care, hence depends on, The types of illnesses prevalent Availability of qualified personnel Priorities set up in health field Need and extent of active community participation. Principles of Primary Health Care: : Principles of Primary Health Care: Equitable Distribution Inter- Sectorial Co-ordination Appropriate Technology Community Participation Empowerment Cultural Sensitinty Self Determinism Focus on prevention Folds of “A” access AFFORD ACCEPT AVAILABLE Components (elements) OF Primary Health Care: : Components (elements) OF Primary Health Care: ELEMENTS: ELEMENTS E- ENSURE SAFE WATER SUPPLY L- LOCALLY CONTROL ENDEMIC DISEASES E- EDUCATION M- MCH E- ENVIRONMENTAL SANITATION N- NUTRITIONAL SERVICES T- TREATMENT OF MINOR ALLINMENTS S- SCHOOL HEALTH SERVICES supportive activities: : supportive activities: S - sectoral collobaration U -utilization of technology P -participation P -provision of resources O -organization & managemenrt O -organization & managemenrt R -research T -training & manpower development Major constraints and problems in carrying out PHC activities in India: : Major constraints and problems in carrying out PHC activities in India: A . Health Aspects B.MCH & FW Aspects C . Operational aspects A . Health Aspects: : A . Health Aspects: A . Health Aspects: High incidence of communicable diseases Wide spread prevalence of malnutrition Scarcity of water and safe water Poor environmental sanitation Problems closely linked with life styles B.MCH & FW Aspects: : B.MCH & FW Aspects: B.MCH & FW Aspects: High infant and maternal mortality Wide prevalence of nutritional deficiencies Poor antenatal care High birth rate and poor effective couple protection Low acceptance of contraceptive methods C.Operational aspects: : C.Operational aspects: C.Operational aspects: Inaccessibility – geographic, financial, cultural and functional. Limited out reach services Poor utilization of health service High illiteracy and superstitions Low health educational activities Low impetus to integrated development Poorly developed infrastructure Less public sector expenditure on health More expenditure for urban area Poor community involvement Drastically inadequate managerial skills Functions of Primary Health Centre: : Functions of Primary Health Centre: Medical care including Referral and laboratory services. Control communicable disease Safe water supply and basic sanitation Maternal and child health services Family planning School Health services Health education Collection of vital statistics Carrying out the National Health Programme Training of Personnel Staffing Pattern: : Staffing Pattern: Staffing Pattern of Primary Health Centre: 1. Medical Officer 1 2. Community Health Officer 1 3. Pharmacist 1 4. Nurse Midwife 1 5. ANM 1 6. Health Educator 1 7. Health Assistant (Male) 1 8. Health Assistant (Female) 1 9. UDC 1 10. LDC 1 11. Lab Technician 1 12. Driver 1 13. Class IV 4 -------- total 16 ------- Population served : 30,000 SUB-CENTRE COVERAGE BY PHC: SUB-CENTRE COVERAGE BY PHC 6-SUBCENTRE COVERGE 1 PHC SC SC SC SC SC SC I.Functions of Medical Officer: : I.Functions of Medical Officer: Medical Officer: General Supervisory Administrative General:: General: He is responsible for all curative and preventive health work in his area, ie . for the functions of the PHC described above. His clinical duties includes, Organizing and conducting the out patients clinics at PHC. Organisation of the indoor service Attending to medico-legal cuses Attending to emergency cues Organising the laboratory service at the PHC. Referring cases to hospital Supervisory: : Supervisory: He supervises and guides the work of other members the staff. He visits sub centres and other villages for this purpose. Administrative: : Administrative: - Co-ordinate and co-operate with other health agencies and voluntary organizations working in the area. -He entists co-operation of other departments such as revenue, agriculture, education and public health engineering for promotion of health and prevention of disease. -Guiding and preparation and checking the preparation of tour programmes of staff. -All matters relating to indents, receipts and maintenance of supplies. -Reporting the progress of activities under all programmes to the Chief Medical Officer. II.Health Worker Female: : II.Health Worker Female: 1.Registration: 2.Care at Home: 3.Care at the Clinic: 4.Care of Community: 5.Others: 1.Registration: : 1.Registration: -Pregnant women from 3 months of pregnancy onwards -Married women in reproductive period -Children through systematic home and at clinics. -Maintain maternity card 2.Care at Home: : 2.Care at Home: -She will provide care to all pregnant women -Distribute folic acid -Immunization -Family Planning -Record and Report birth and death . Care at the Clinic: : Care at the Clinic: -Arrange and help HO and Health Assistant in conducting MCH and Family Planning Clinics at the sub centre. -Conduct urine examination and estimate Hb %. Care of Community: : Care of Community: -She will identify women leaders and help the health assistant (f) and participate in the training of women leaders. -Set up women depot holder for condom distributions. -Participate in meetings -Utilize satisfied customers, village leaders, dais and others for promoting family welfare programme . Others:: Others: 5.Others: -Cleanliness of the centre -Attend staff meeting at PHC, CD block or both III.Male Health Workers: : III.Male Health Workers: Record keeping Malaria Communicable disease Leprosy Tuberculosis Environmental sanitation Expanded programme on immunization Family Planning IV.Health Assistant (Male & Female):: IV.Health Assistant (Male & Female): Supervise the health workers -Control of blindness, vital statistics (Male) The health assistant supervise and the health care services to the community. Strengthen the knowledge and skills of health workers in their different areas. Help the health workers in improving their human relations skill. Help and guide the health workers in planning and organizing their programme . Promote learn work among the health workers Coordinate activities with other workers and agencies Visit each worker periodically Arrange group meetings with leaders and involve them in spreading the message for various. V.Function of Pharmacist:: V.Function of Pharmacist: V.Function of Pharmacist: Distribution of medical programme Equipment storage Maintain stock register VI. Staff Nurse: : VI. Staff Nurse: Conducting delivery Administration of injection Medication distribution VII.ANM:: VII.ANM: Conducting delivery Administration of injection Medication distribution The WHO study group (1985) identified four main self-explanatory roles in primary health care. : The WHO study group (1985) identified four main self-explanatory roles in primary health care. Nurse as a direct care provider Nurse as a teacher and educator Nurse as a supervisor and manager Nurse as a researcher and evaluator Major Roles of Nurses in PHC: : Major Roles of Nurses in PHC: Facilitator Role Developmental Role Supportive Role Supervision Training Management Programme Planning Policy Making Programme Implementation Programme Evaluation Required Skillfor nurses: : Required Skillfor nurses : a.Social Process Skills: b.Problem solving skills: c.Other Skills: Role of Nurses in PHC: : Role of Nurses in PHC: Role of Nurses in PHC: Maintaining records and reports Conducting camp Area visit Immunization Conducting school health programme Verification Over all supervision Immunization PowerPoint Presentation: Health Education .Food Supply and Proper Nutrition Maternal and Child Health including F.P. Water Supply and Basic Sanitation Prevention and Control of Locally Endemic Diseases: Treatment of Minor Ailments: Provision of Essential Drugs: Norms : Norms s.no Indicator population National norms rural National norms Hill area Present average coverage 1 population Coverage Sc Phc chc 2 No of sc per 1 phc 6 6 3 No of phc per chc 4 4 Community health centre: Community health centre PowerPoint Presentation: CHCs are being established and maintained by the State Government under MNP/BMS programme a CHC is required to be manned by four Medical Specialists i.e. Surgeon, Physician, Gynecologist and Pediatrician supported by 21 paramedical and other staff (See Annexure-D for IPHS norms). It has 30 in-door beds with one OT, X-ray, Labour Room and Laboratory facilities. It serves as a referral centre for 4 PHCs and also provides facilities for obstetric care and specialist consultations First Referral Units (FRUs) : First Referral Units (FRUs) First Referral Units (FRUs) An existing facility (district hospital, sub-divisional hospital, community health centre etc.) can be declared a fully operational First Referral Unit (FRU) only if it is equipped to provide round-the-clock services for Emergency Obstetric and New Born Care, in addition to all emergencies that any hospital is required to provide. PowerPoint Presentation: It should be noted that there are three critical determinants of a facility being declared as a FRU : i ) Emergency Obstetric Care including surgical interventions like Caesarean Sections; ii) New-born Care; iii) Blood Storage Facility on a 24-hour basis. THANK U……..: THANK U……..