DELIVERY OF COMMUNITY HEALTH SERVICES BSC 4 TH YR.pptx

Delivery of community Health Nursing BSC NURSING 4THtear

1. Delivery of Community Health Services Amit Singh Nursing Tutor K.I.N.P.S. Lucknow

2. Planning, Budgeting and Material Management of SCs , PHC and CHC

3. National Rural Health Mission (NRHM), the public health institutions in rural areas are to be upgraded from its present level to the level of a set of standards called in Indian Public Health Standards (IPHS)". The quality of services is not uniform, due to various reasons like non availability of manpower, problems of access, acceptability, lack of community involvement . INTRODUCTION

4. These standards must be followed by the sub centre (SC), primary health centre (PHC), community health entre (CHC), sub divisional hospital, sub district hospital and district hospital. In primary health are rural health services are developed into a three tier system according to the size of population. Introduction

5. Rural Health Care System In India Sub-Centre Level 5-6 villages 3000-5000 population. Most Peripheral first point of contact between primary health care and community . Primary Health Centre Level 30-40 villages 20,000-30,000 population A referral unit for 5 sub centre. 4-6 bedded under medical officer in charge with 14 subordinate Community Health Centre Level 1000 villages. 80,000-1,20,000 population. "A 30 bedded hospital/first referral unit. 4 PHC with special services.

6. Planning- According to Haimann , "Planning is deciding in advance what is to be done. When a manager plans, he projects a course of action for further attempting to achieve a consistent coordinate structure of operations aimed at the desired results". Definition

7. Budgeting – Budget is an operational plan, for a definite period usually one year expressed in financial terms and based on expected income and expenditure". Definition

8. Material Management- "Material management is concerned with providing the drugs, supplies and equipments needed by health personnel to deliver health services". Definition

9. Introduction- In the public sector, a sub-centre is the most peripheral and first point of contact between the primary health care system and the community. A sub-centre provides interface with the community SUB-CENTRE (SC)

10. A sub-centre provides interface with the community. This is the first unit of heal system for villagers. As per population norms, there should be one sub- center established for every 5000 population in plain areas and for every 3000 population in hilly/ trib -desert areas. Definition

11. 1. To provide basic primary health care to the community. 2 . To achieve and maintain an acceptable standard of quality of care. 3 . To make the services more responsive and sensitive to the needs of the community . 4 . To facilitate supervision and monitoring of health services. Objectives of Sub-centre

12. In view of the current highly variable situation of sub centres in different parts of the country and even within the same state, they have been categorized into two type – Type A and Type B Sub-centre. Type A conducting delivery will not be available here. If the requirement for this goes up, the sub centre may be considered for up gradation to Type B . Categories of Sub-centre

13. Type B Sub-centre: 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 subcentre . Categories of Sub-centre

14. A sub-centre should have its own building In a central location with easy access to population. Sub-centre to be located within the village for providing easy access to the people and safety of the ANM. As possible no person has to travel more than 3 km to reach the sub-centre. Physical Infrastructure of Sub-centre

15. Type B sub-centre should have, about 4 to 5 rooms with facilities of, waiting room, one labour room with one labour table and new born corner, one room with two to four beds (in case the no. of deliveries at the sub-centre is 20 or more, four beds will be provided) one room for store, one room for clinic/office, one toilet facility each in labour room, ward room and in waiting area Physical Infrastructure of Sub-centre

16. Sub-centres are expected to provide promotive , preventive and few curative primary health care services as explained below : Maternal health: Antenatal care, intra-natal care and postnatal care . Child health: Essential new born care and immunization services . Services Provided at Sub-centre

17. Family planning and contraception: Motivation and counselling and provision of contraceptives . Adolescent health care: Education, prevention and treatment of anemia School health services: Screening, treatment of minor ailments, immunization. Control of local endemic diseases: Such as Malaria, Kala- azar , Japanese encephalitis, Services Provided at Sub-centre

18. Safe abortion services (MTP): Counselling and appropriate referral for safe abortion services and follow up after abortion . Water quality monitoring: Disinfection of drinking, promotion of sanitation . Curative services: Provide treatment for minor ailments . Coordination and monitoring: Coordinating the services with AWW, ASHA and village health and sanitation committee. Services Provided at Sub-centre

19. Manpower at sub-centre Type of sub-centre Staff ANM/Health Worker (female ) - 1 Health Worker (male ) - 1 Staff Nurse or ANM - 1 Safai-Karamchari “ - 1 Manpower at Sub-centre

20. National Rural Health Mission envisages providing fund to each sub-centre with 10,000 per sub centre as per district list. The fund to be kept under Joint Bank/Post Office account in the name of sub-centre Management . Budgeting for Sub-Centre

21. Basin, kidney tray sterilization kit and vaccine carrier, plastic sheets, instrument/dressing tray, dressing jar with cover, scale bathroom metric and, weighing hanging type color coded 5 kg, uterine forceps vulsellum curved, vaginal speculum, cord cutting scissors and clip, tissue forceps, surgical scissors straight, reagent strips for urine test, depressor/retractor, jug scale , etc. Equipment at Sub-centre

22. Drug kit A for sub- centre - Oral rehydration salt Drug kit B for sub – centre - Tab- methylergometrine Additional drugs required at Birth by ANM - inj - gentamycin Drugs for sub-centre

23. Introduction- An integrated curative and preventive health care to the rural population with emphasis on preventive and promotive aspects of health care. PHC for every 30,000 rural population in the plain area and 20,000 population in hilly, tribal and backward areas for more effective coverage. It acts as a referral unit for 6 sub-centres and refers out cases to community health centres and higher order public hospitals at sub-district and district hospitals. PRIMARY HEALTH CENTRE

24. To provide comprehensive primary health care to the community through the primary health centres To achieve and maintain an acceptable standard of quality of care . To make the services more responsive and sensitive to the needs of the community. Objectives of PHC

25. Assured services cover all the essential elements of preventive, promotive , curative and rehabilitative primary health care. This implies a wide range of services that include : Medical care: OPD services 4 hours in the morning and 2 hours in the afternoon / evening 24 hours emergency services for appropriate management of injuries and Services Provided at PHC

26. accident, first aid, stabilization of the patient before referral. Maternal care : Antenatal care: Early registration of all pregnancies ideally in the first trimester (before 12 th week of pregnancy). Minimum 4 antenatal check ups and provision of complete package of services. Services Provided at PHC

27. Intra-natal care: Promotion of institutional deliveries and conducting of normal deliveries Manual removal of placenta and appropriate and prompt referral for cases needing specialist care. Postnatal care: A minimum of 2 postpartum home visits, 1st within 48 hours of delivery, 25 within 7 days. Initiation of early breast-feeding within half-hour of birth. Services Provided at PHC

28. Child care : Facilities for neonatal resuscitation and management of neonatal hypothermia jaundice. Emergency care of sick children. Promotion of exclusive breastfeeding for 6 months Full immunization of infants and children. Family planning: Education, motivation and counselling to adopt appropriate family planning methods. Provision of contraceptives, permanent methods. Services Provided at PHC

29. Management of reproductive tract infections / sexually transmitted infections : Health education for prevention and treatment of RTI/ STIs. Nutrition services: School health for regular check up, appropriate treatment, referral and follow-up. Adolescent health care like life style education, counselling, appropriate treatment. Services Provided at PHC

30. Disease surveillance and control of epidemics: Disinfection of water sources and testing of water quality using H₂S Strip . Training: Training of ASHA, health workers and trained birth attendants, doctors on emergency obstetric care. Services Provided at PHC

31. Manpower at PHC

32. Introduction- Community Health Centres (CHC constituting the First Referral Units (FRUs) and the Sub-district and District Hospitals. The CHC designed to provide referral health care for cases from the Primary Health Centres level and for cases in need of specialist care approaching the centre directly . COMMUNITY HEALTH CENTRE (CHC)

33. To provide optimal expert care to the community . To achieve and maintain an acceptable standard of quality of care. To make the services more responsive and sensitive to the needs of the community. Objectives of CHC

34. The CHC should have 30 indoor beds with one operation theatre, labour room, X-ray, ECG an laboratory facility. The centre should be located at the center of the block headquarter in order improve access to the patients. Building structure and the internal structure should be made. Disaster proof especially earthquake proof, flood proof and equipped with fire protection measure. Physical Infrastructure of CHC

35. The CHC designed to provide referral health care for cases from the primary level and for cases in need of specialist care approaching the centre directly. OPD and IPD services like general, medicine surgery, obstetrics and gynecology , pediatrics , dental and AYUSH services. Services Provided at CHC

36. Care of routine and emergency cases in surgery: Surgery for hernia, hydrocele, appendicitis hemorrhoids , fistula, etc. handling of emergencies like intestinal obstruction, hemorrhage . Care of routine and emergency cases in medicine: Handling of all emergencies, 24-hour delivery services including normal and assisted deliveries, interventions like caesarean sections and other medical interventions. Services Provided at CHC

37. Maternal Health (same as PHC New-born Care and Child Health (same as PHC). Family Planning (same as PHC ). National health programmes communicable and non communicable disease programme Services Provided at CHC

38. Untied Fund for FRU(first referral unit) and for add 50,000 is being released. Suggested areas where Untied Fund may be used include: Minor modifications to the Centre- curtains to ensure privacy ,repair of taps other minor repairs which can be done at the local level. Patient examination able, delivery table, BP apparatus, hemoglobinometer , copper-T insertion kit, instruments baby tray, weighing scales for mother etc. United fund for CHC

39. Standard Surgical Set - I and II: Trays, instruments/dressing material, gloves, surgeon forceps backhaus , towel, sponge, holding hemostatic , halstead mosquito, needles, hypodermic, etc . CHC Standard Surgical Set - III : Tray, instrument/dressing with cover, forceps, backha towel, forceps hemostat , straight kelly , forceps hemostat curved kelly , etc. Equipment for CHC

40. IUD Insertion Kit: Tray with cover, gloves, surgeon bowl, metal sponge forceps, uterine simpson sound anterior vaginal wall retractor, speculum vaginal . Normal Delivery Kit: Trolley towel, gown, cap, gauze absorbent macintosh , mask, cotton wool drum, sterilizing cylindrical, instrument Materials Kit for Blood Transfusion: Bovine albumin pipette, test-tube, cuff, sphygmomanometer forceps, artery, scissors, anticoagulant, microscope catheter, etc. Equipment for CHC

41. Equipment for Neonatal Resuscitation: Catheter, nasal catheter, endotracheal, stilette , laryngoscope, lateral mask, resuscitator, lamp, etc.t table. Equipment for Operation theatre: Diathermy machine, dressing drum, lamps, sterilizer, suction apparatus, stand with wheel for single basin, operation table, trolley for patients, trolleyfor instruments, Equipment for CHC

42. Equipment for Labour Room: Lamps, table, trolley, torch, trays, vacuum extractor, weighing machine for babies, wheel chairs, etc . Equipment for Radiology: Aprons, lead rubber, X-ray, dark room accessories, film clips, lead sheets, X-ray view box, X-ray film processing tank, etc. Equipment for CHC

43. Drugs at CHC Essential Drugs like Lignocaine Hydrochloride, Diazepam, Acetyl Salicylic Acid, Ibuprofen, Paracetamol , Pentazocine Lactate, Chloroquine Phosphate, Adrenaline , Phenytoin Sodium, Albendazole , Amoxicillin, Ciprofloxacin Hydrochloride, Norfloxacin , Doxycycline, Metronida zole , Oxygen, etc. Drugs at CHC

44. Eligible couple register including contraception . Maternal and Child Health Register : Antenatal , Intra-natal , Postnatal. Above five child immunization Number of HIV/STI screening and referral. Under-five register: Immunization and growth monitoring 3 . Births and Deaths Register . Records Maintained at Health Centre

45. Drug Register. Equipments , furniture and other accessories, register communicable diseases/epidemic register. Register for water quality and sanitation. Register for records J anani Suraksha Yojana Records Maintained at Health Centre

46. The country is Health system of India also represents the organization of health services in divided into 28 major there are 647 union territories which in turn are divided into administrativs districts. At presented community districts . Sub-centres and village constitute the most peripheral government health institutional facility. Organization ,Staffing and Functions of Rural Health Services

47. Health care delivery system in rural areas Organization, staffing and functions of rural health services - Village Sub-centre Primary health centre Community health centre /sub-divisional hospitals Hospital District State Centre

48. Rural organization a t village level   Village health guides Anganwadi workers Asha Local Dai / TBA(   Traditional birth attendant  )

49. Indian government introduced a community health worker (CHW) scheme across the country in 1977, provision of health services at the doorsteps of villager. However, the names of the worker and the scheme changed over time - from CHW in 1977 to Community Health Volunteer in 1980 and Village Health Guides in 1981. Village health guides

50. To provide basic curative, preventive, and promotive health care at the door- steps of the people. To involve rural people in the provision , monitoring and control of basic health services , to place people’s health in people’s hand. To create a resources person trusted by the local population who could provide a link between primary health centre and local community. Objectives

51. Anganwadi are India's primary tool against the Punishment of child malnourishment, infant mortality and curbing preventable diseases such as polio. Anganwadi were started by the Indian government in 1975 as part of the Integrated Child Development Services programme to combat child hunger and malnutrition . Anganwadi workers

52. The Anganwadi system is mainly managed by the Anganwadi worker. She is a health worker chosen from the community and given 4 months training in health, nutrition and child-care. She is incharge of an Anganwadi which covers a 1000 population. Continue….

53. Organizing health day once/twice a week. On health day , the women,adolescnet girls and children from the village will be invited for orientation on health related issues such as importance of nutritious food, personal hygiene, care during pregnancy , importance of antenatal check up and institutional delivery, home remedies for minor ailments and importance of immunization, etc. Role of Anganwadi worker

54. One of the key components of the National Rural Health Mission is to provide every village in the country with a trained female community health act visit ASHA. ASHA programme were issued by the Ministry of Health and Family Welfare ( MoHEW ) in 2006 The general norm is 'One ASHA per 1000 population', when the population exceeds one thon 2006 another ASHA can be engaged. Accredited Social Health Activist (ASHA)

55. ASHA must be a woman resident of the village preferably Married! Widow/Divorced/Separated' and preferably in the age group of 25 to 45 years. ASHA should have effective communication skills, leadership qualities and be able to reach out to the community. she should be a literate woman with formal education up to eighth class. Continue….

56. ASHA will take steps to create awareness and provide information to the community on determinants of health such as nutrition, basic sanitation and hygienic practices, healthy living, and working conditions. She will counsel women on birth preparedness, importance of safe delivery, breastfeeding and complementary feeding, immunization, contraception and prevention of common infections. Role of ASHA

57. The female traditional birth attendants conducting deliveries at home, mostly in the rural areas in India are known as the ‘dais ’. There are at least one or more dais for each village . They live and work in the same community, hence have good rapport with the villagers. They are quite often illiterate. Local Dai/ TBA