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DELIVERY OF COMMUNITY HEALTH SERVICES

DELIVERY OF COMMUNITY HEALTH SERVICES. HEALTH CARE SYSTEMS. The health care system is intended to deliver the health care services. It constitutes the management sector and involves organizational matters, it operates in the context of the socioeconomic and political framework of the country.

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DELIVERY OF COMMUNITY HEALTH SERVICES

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  1. DELIVERY OF COMMUNITY HEALTH SERVICES ANANDA.S ASST.PROFESSOR YNC

  2. HEALTH CARE SYSTEMS • The health care system is intended to deliver the health care services. • It constitutes the management sector and involves organizational matters, it operates in the context of the socioeconomic and political framework of the country. • In India, it is represented by five major sectors or agencies which differ from each other by the health technology applied and by the source of funds for operation. ANANDA.S ASST.PROFESSOR YNC

  3. 1. Public health sector ANANDA.S ASST.PROFESSOR YNC

  4. 2. Private Sector (a) Private hospitals, polyclinics. Nursing homes, and dispensaries (b). General practitioners and clinics ANANDA.S ASST.PROFESSOR YNC

  5. 3. indigenous systems of medicine • Ayurveda and Siddha • Unani and Tibbi • Homoeopathy • Unregistered practitioners ANANDA.S ASST.PROFESSOR YNC

  6. 4. Voluntary health agencies 5. National health programmes ANANDA.S ASST.PROFESSOR YNC

  7. Organization, Planning, Budgeting and Material management of SC, PHC, CHC ANANDA.S ASST.PROFESSOR YNC

  8. Under NRHM, the public health institutions in rural areas are to be upgraded from its present level to the level of a set standards called “Indian Public health Standards (IPHS)” • The quality of services is not uniform, due to various reasons like- Non availability of manpower, problem of access, acceptability, lack of community involvement etc. ANANDA.S ASST.PROFESSOR YNC

  9. Standards are being introduced in order to improve the quality of public health level. • These standards must be followed by the sub centre, Primary health centre, community health Centre, sub divisional hospital, sub district hospital and district hospital ANANDA.S ASST.PROFESSOR YNC

  10. In primary health care, rural health services are developed into a three tier system according to the size of population. ANANDA.S ASST.PROFESSOR YNC

  11. SUB-CENTRE (SC) • A sub-centre is the most peripheral and first point of contact between the primary health care system and community. • SC provides all the primary health care services at the grass-root level. • The purpose of the SC is largely preventive and promotive, basic level of curative care. ANANDA.S ASST.PROFESSOR YNC

  12. As per population norms , • One sub-centre – 3000 population (Hilly/Tribal/Difficult areas) --5000 population (Plain areas) • In 2011 --- Total Sub-centre =1,48,124 ANANDA.S ASST.PROFESSOR YNC

  13. OBJECTIVES • To provide basic health care to the community • To achieve and maintain an acceptable standard of quantity of care • To make the services more responsive and sensitive to the needs of the community • To facilitate supervision and monitoring of health services ANANDA.S ASST.PROFESSOR YNC

  14. Categories of Sub-centre • Type A: Shall provide all services as envisaged for the Sub-centre except the facilities for conducting delivery will not be available here. • Type B: They will provide all recommended services including facilities for conducting deliveries at the Sub-centre itself. This Sub-centre will act as Maternal and Child Health (MCH) centre with basic facilities for conducting deliveries and Newborn Care at the Sub-centre. ANANDA.S ASST.PROFESSOR YNC

  15. Services provided at SC 1. Maternal health care : Antenatal care : (a) Early registration of pregnancy -(ideally before 12 weeks of pregnancy). Minimum three antenatal check-ups. Recording of general check-up, weight, blood pressure, abdominal examination, hemoglobin, routine urine examination and blood group. (b) Folic acid supplementation from first trimester and folic acid and iron supplementation from 12 weeks onwards ANANDA.S ASST.PROFESSOR YNC

  16. (c) Tetanus toxoid immunization (d) Identification of high-risk pregnancy and referral (e) Counselling on diet, pre-birth preparedness and rest ANANDA.S ASST.PROFESSOR YNC

  17. Intranatal care : (a) Promotion of institutional deliveries; (b) Skilled attendance at home deliveries; and (c) Appropriate and prompt referral in case of complications. ANANDA.S ASST.PROFESSOR YNC

  18. Post-natal care: (a) Minimum of 2 post-partum home visits, first within 48 hours and 2nd within 7 days of delivery (b) Initiation of breast feeding within 1/2. hour of delivery (c) Counselling on diet, hygiene and contraception; and (d) Provision of facilities of JananiSurakshaYojana. ANANDA.S ASST.PROFESSOR YNC

  19. 2. Child health care : • Essential new born care as per guidelines (b) Promotion of exclusive breast feeding for 6 months (c) Full immunization of all infants and children against vaccine preventable diseases (d) Vitamin A prophylaxis (e) Prevention and control of childhood diseases like malnutrition, ARI, diarrhoea etc. ANANDA.S ASST.PROFESSOR YNC

  20. 3. Family Planning and Contraception (a) Education, motivation and counselling to adopt appropriate family planning method (b) Provision of contraceptives such as condoms, oral pills, emergency contraceptives and IUD insertion (wherever ANM is trained for IUD insertion) (c) Follow up services to the eligible couples adopting permanent methods of tubectomy and vasectomy. ANANDA.S ASST.PROFESSOR YNC

  21. 4. Counselling and appropriate referral for safe abortion service (MTP) 5. Adolescent health care - Education, counselling and referral 6. Assistance to school health services. 7. Water quality monitoring. 8. Promotion of sanitation including use of toilet and appropriate garbage disposal ANANDA.S ASST.PROFESSOR YNC

  22. 9. Field visits by appropriate health workers for disease surveillance, family welfare services including STI, RTI awareness. 10. Community need assessment. 11. Curative services for minor ailments including fever, diarrhoea, worm infestation and first-aid, appropriate and prompt referral. • To organize Health Day at anganwadicentres at least once in a month. • To provide AYUSH treatment. ANANDA.S ASST.PROFESSOR YNC

  23. 12. Training of Traditional Birth Attendants and ASHA/ community health volunteers. 13. Co-ordinate services of anganwadi workers, ASHA, village health and sanitation committee etc. 14. National health programmes. ANANDA.S ASST.PROFESSOR YNC

  24. Manpower at Sub-centre ANANDA.S ASST.PROFESSOR YNC

  25. DRUGS FOR SC ANANDA.S ASST.PROFESSOR YNC

  26. ANANDA.S ASST.PROFESSOR YNC

  27. PRIMARY HEALTH CENTRE INTRODUCTION • Primary health centers are the corner stone of rural health services . • It act as a referral unit for 6 sub centers and refer out cases to CHCs . • It covers a population of 30,000 in plain area and 20,000 in hilly and tribal area. • There are 4-6 beds for patients and some diagnostic facilities are also available. • In 2014, Total PHC = 25,020 ANANDA.S ASST.PROFESSOR YNC

  28. DEFINITION • The primary health center (PHC) is the basic structural and functional unit of the public health services in developing countries, to provide accessible, affordable, and available primary health care to people. ANANDA.S ASST.PROFESSOR YNC

  29. OBJECTIVES • To provide comprehensive primary health care to the community at PHCs. • To achieve and maintain an acceptable standards of quality of care . • To make the services more responsive and sensitive to the need of the community ANANDA.S ASST.PROFESSOR YNC

  30. Functions of the PHC The functions of the primary health center in India cover all the elements of primary health care as outlined in the Alma-Ata Declaration. They are : 1. Medical care 2. MCH including family planning 3. Safe water supply and basic sanitation 4. Prevention and control of locally endemic diseases 5. Collection and reporting of vital statistics 6. Education about health 7. National Health Programmes - as relevant 8. Referral services 9. Training of health guides, health workers, local dais and health assistants 10. Basic laboratory services ANANDA.S ASST.PROFESSOR YNC

  31. SERVICES PROVIDED AT PHC 1. MEDICAL CARE : a) OPD services : 4 hours in the morning and 2 hours in the afternoon/evening. b) 24 hours emergency services: appropriate management of injuries and accident, First-aid, stabilization of the condition of patient before referral, dog bite/snake bite/ scorpion bite cases, and other emergency conditions (c) Referral services (d) In-patient services (6 beds). ANANDA.S ASST.PROFESSOR YNC

  32. 2. MATERNAL AND CHILD HEALTH CARE • Antenatal care • Intranatal care • Postnatal care • New born care • Care of the child ANANDA.S ASST.PROFESSOR YNC

  33. 3. Full range of family planning services including counselling and appropriate referral for couples having infertility. 4. Medical termination of pregnancy using manual vacuum aspiration technique 5. Health education for prevention and management of RTl/STI. 6. Nutrition Services : Diagnosis ·and management of malnutrition, anaemia and vitamin A deficiency and coordination with ICDS. ANANDA.S ASST.PROFESSOR YNC

  34. 7. School health services. 8. Adolescent health care. 9. Disease surveillance and control of epidemics 10. Collection and reporting of vital events. 11. Promotion of sanitation including use of toilet and appropriate garbage disposal. 12. Testing of water quality and disinfection of water sources. 13. National health programmes. ANANDA.S ASST.PROFESSOR YNC

  35. 14. Appropriate and prompt referral of cases needing special care and providing transport facilities 15. Record of vital events, reporting of births and deaths, and maintenance of all relevant records concerning services provided in PHC. 16. Training 17. Basic laboratory services 18. Monitoring and supervision : ANANDA.S ASST.PROFESSOR YNC

  36. 19. Selected surgical procedures The vasectomy, tubectomy (including laparoscopic tubectomy), MTP, hydrocelectomy and cataract surgeries as a camp/fixed day approach have to be carried out in a PHC having facilities of O.T. 20. Mainstreaming of AYUSH ANANDA.S ASST.PROFESSOR YNC

  37. DRUGS AT PHC • Inj.Diazepam • Inj.Lignocaine • Inj.Pethidine • Inj.Pentazocine lactate • Inj.Dexamethasone sodium phosphate • inj.Promethazine • Inj.Adrenaline • Inj.Ethophylline , Theophylline and Inj.Aminophylline • Inj.Methylergometrine etc. ANANDA.S ASST.PROFESSOR YNC

  38. MANPOWER at PHC ANANDA.S ASST.PROFESSOR YNC

  39. COMMUNITY HEALTH CENTRE (CHCs) • Health care delivery in India has three levels- Primary, Secondary and Tertiary • The secondary level of health care essentially includes community health centres (CHCs) with First referral Units (FRUs) • CHCs designed to provide referral health care for cases from the primary health centres. • 4 PHCsare included under each CHCs • One CHC---80000 populations in hilly /tribal areas 1,20,000 population in Plain areas ANANDA.S ASST.PROFESSOR YNC

  40. CHC is a 30 Bedded hospital providing specialist care in Medicine, Obstetrics and Gynecology, Surgery, pediatrics, Dental and AYUSH. • In 2014- total CHCs =5,363 ANANDA.S ASST.PROFESSOR YNC

  41. Objective • To provide optimal, expert care to the community. • To achieve and maintain an acceptable standards of quality of care . • To make the services more responsive and sensitive to the need of the community ANANDA.S ASST.PROFESSOR YNC

  42. Services provided at CHC 1. Care of routine and emergency cases in surgery: a. This includes incision and drainage, and surgery for hernia, hydrocele, appendicitis, haemorrhoids, fistula, etc. b. Handling of emergencies like intestinal obstruction, haemorrhage, etc. ANANDA.S ASST.PROFESSOR YNC

  43. 2. Care of routine and emergency cases in medicine: Handling of all emergencies in relation to the national health programmes as per guidelines like dengue/DHF, cerebral malaria, etc. 3. 24-hour delivery services, including normal and assisted deliveries. 4. Essential and emergency obstetric care including surgical interventions like caesarean sections and other medical interventions. ANANDA.S ASST.PROFESSOR YNC

  44. 5. Full range of family planning services including laproscopic services. 6. Safe abortion services. 7. Newborn care 8. Routine and emergency care of sick children. 9. Other management, including nasal packing, tracheostomy, foreign body removal etc 10. All the national health programmes (NHP) should be delivered through the CHCs ANANDA.S ASST.PROFESSOR YNC

  45. 11. Others: a. Blood storage facility b. Essential laboratory services c. Referral (transport) services ANANDA.S ASST.PROFESSOR YNC

  46. Manpower at CHC ANANDA.S ASST.PROFESSOR YNC

  47. ANANDA.S ASST.PROFESSOR YNC

  48. ANANDA.S ASST.PROFESSOR YNC

  49. DRUGS at PHC Phenytoin Albendazole Amoxicillin Ciprofloxacin Co-trimoxazole Norfloxacin Doxycycline Methronidazole Oxygen etc. • Lignocaine Hydrochloride • Diazepam • Pentazocine • Chloroquine • Adrenaline • Prednisolone • Promethazine • Phenobarbitone ANANDA.S ASST.PROFESSOR YNC

  50. Organization, staffing and functions of Rural Health Services ANANDA.S ASST.PROFESSOR YNC

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