Comprehensive Guide to Health Care Delivery System in the Community

1. Health Care of the community Dr Abhay Nirgude

2. Specific Learning Objectives • Enumerate the components of health care delivery system. • Write the functions of Health worker Male/Female. • Write the functions of Health assistant Male/Female

3. Model of Health Care Delivery System Health care services Health care systems Inputs Outputs Health status or health problems Curative Preventive Promotive Public Private Voluntary Indigenous Changes in health status Resources

4. Health status & health problems Known as Community diagnosis • Demographic • Morbidity & mortality profile • Environmental • Socio economic and cultural • Medical & health services available

5. Resources • Manpower • Money • Materials • Minutes

6. Manpower • Includes both professional and auxiliary • Based on a series of accepted ratios

7. Money and materials • Developed countries – 6-12% GNP • In underdeveloped countries - <1% • In India – 3%

8. Health care services In India, 5 major sectors A. Public health sector • Primary health care • PHC and subcentres • Hospitals/ health centres • CHC, rural hospitals, district hospitals, specialist and teaching hospitals • Health insurance schemes • ESI, Central Govt Health Scheme • Other agencies • Defence , Railways

9. Health care services B. Private sector • Private clinics, nursing homes, GP C.Indigenous systems of medicine • Ayurveda, Unani, Homeopathy, Unregistered practitioners D. Voluntary health Agencies E. National Health Programmes

10. Primary health care • Govt has laid down National Health goals so as to achieve Health for All by 2000 • Laid down plan of action To achieve universal coverage and equitable distribution at the village level • Village health guides • Training of local dais • ICDS Scheme

11. Village level Village Health Guides • Criteria for selection • Post selection • Duties include • Treatment • MCH and FP • Health education and sanitation

12. Village level Local Dais • Train all categories of TBA • Dai kit Anganwadi worker ASHA/USHA

13. Subcentre level • 1 subcentre for 5000 population • 1 Male and 1 female HW • MCH , FP, Immunization

14. Primary health centre • In 1953 PHC covered a population of 100,000 • In 1977 reorganised based on Alma atta conference to 30,000 for plains and 20,000 for hilly areas

15. Primary health centre Staffing pattern • Medical Officer 1 • ANM 2 • Block extension educator 1 • Health assistant (male and female) 1 • UDC & LDC 2

16. Primary health centre Functions • Medical care • MCH , FP • Safe water and basic sanitation • Prevention and control of loclly endemic diseases • Collection and reporting of vital statistics • Education about health • National Health programmes • Referral services • Training of health guides, health workers • Basic lab services

17. Community health centres Staff • MO 4 • Nurse midwives 7 • Lab technician 1 • Radiographer 1

18. Hospitals • Preventive , promotive, Curative • Specific catchment area • Medical & paramedical workers

19. CGHS Insurance • OPD care • Supply of drugs • Lab and X ray investigation • Domiciliary visit • Hospitalization facility at Govt • Specialist consultation • Paediatric • Antenatal, postnatal • Emergency treatment • Supply of optic and dental aids • Family welfare services

20. Voluntary Health agencies An organisation administered by an autonomous board which holds meeting, collects funds chiefly from private sources, works with or without paid workers and helps in providing health services, health education, legislation or research.

21. Voluntary Health agencies Functions • Supplementing the work of the Govt services • Pioneering • Education • Demonstration • Legislation

22. Voluntary Health agencies • Indian Red Cross Society • Hind Kusht Nivaran Sangh • Indian Council of Child welfare • TB Association of India • Bharat Sevak Samaj • Central Social Welfare Board • Kasturba Memorial fund • FPA of India

23. Indian Red Cross Society • Relief Work • Milk and Medical supplies • Armed Forces • Maternal and child welfare services • Family planning • Blood bank and first aid

24. Indian Public Health Standards • Indian Public Health Standards(IPHS) are a set of standards envisaged to improve the quality of health care delivery in the country under the National Rural Health Mission. • What is need for IPHS? • Authority :- Task group under Director General of Health Services

25. Objectives of IPHS • To provide optimal support care to the community • To achieve and maintain an acceptable standards of quality of care. • To make the services more responsible and sensitive to the needs of the community

26. Indian Public Health Standards • Sub center • Primary health center • Community Health Center • District Hospitals

27. IPHS – Sub Centres • Maternal Health care :- ANC, INC • Child health care • Family planning & Contraception • Counselling & Referrals for abortion • Adolescent health education • Assistance in school health services

28. IPHS – Sub Centres • Water quality monitoring • Promotion of sanitation • Field visits • Community need assessment • Curative services :- first aid, referral, health day • Training of ASHA/CHV • National Health Programs

29. IPHS- Primary health care • Objectives:- • Medical care:- OPD, 24 hour emergency, referral, IPD (6 Beds) • MCH care :- ANC, INC, PNC • New born care • Care of the child

30. IPHS- Primary health care • Family planning & Contraception • Counselling & Referrals for abortion • Adolescent health care • School health services • Collecting and reporting vital events • Promotion of sanitation • Testing of water quality and disinfection of water sources

31. IPHS- Primary health care National Health Programs:- Record of events Training Basic laboratory services Monitoring & supervision Selected surgical procedures Mainstreaming Ayush

32. IPHS – Community Health Centres • Care of routine & emergency cases in surgery • Care of routine & emergency cases in Medicine • 24 x 7 services • Essential & Emergency Obstric services • Safe abortion services • National Health programs

33. Newborn Care Stabilization Unit • Services at stabilization unit :- Provision of warmth. Resuscitation. Supportive care including oxygen, drugs, IV fluids. Monitoring of vital signs, including blood pressure. Breast feeding/feeding support. Referral Services

34. Configuration of stabilization Unit • Location :- Close proximity to emergency ward • Space :- 40-50 sq ft per bed is needed, where 4 radiant warmers will be kept. • Provision of hand washing and containment of infection control.

35. Human Resource & Training • One Staff Nurse :- On rotation 24X7 • Pediatrician of FRU :- Inchagre of the Stabilization unit • Additional staff nurse as per need • Doctors and Nurses posted at Stabilization Unit will undergo Facility based care training.

36. Referral services & Transport • Each Unit accepting neonatal and sick child referrals should have, or have access to, an appropriately staffed and equipped transport service.

37. Equipments

38. Consumables

39. Indian Public Health standards • District Hospitals

40. Job description – HW Female • Registration • Care at Home • Nutritional advice • IFA and TT, Vit A • Referral for complicated preg and deliveries • Conduct deliveries • Give postnatal advice • Supervise deliveries by dais • FP advice • Distribute contraceptives • Growth monitoring camps • Immunization • Management of minor ailments • Vital statistics • Basic investigations • Referral for MTP

41. Job description – HW Female • Care at clinic • Arrange MCH & FP clinics • Health education • Care in community • Set up depots for condom distribution • Health education

42. Job description – HW Male • Record maintainence • Malaria • Leprosy • Tuberculosis • Communicable diseases • Identify - diarrhoea, dysentry, diptheria, jaundice • Control measures • Identify cases of blindness and STDs

43. Job description – HW Male • Environmental sanitation • Chlorinate wells • Educate about sanitation • Immunisation • FP

44. Job description – H Assistant Male • Malaria • Supervise spraying of insecticides • Give radical treatment • Surveillance • Take control measures for communicable diseases • Ensure regular treatment of leprosy and TB patients • Help construction of sanitary latrines

45. Job description – H Assistant Female • Supervisory house visits and subcentre visits • Guide in holding contraceptive depots, MCH and FP clinics, training for dais, Immunization clinics • Motivate resistant cases for FP

46. Summary