Unit 7 health team

COMMUNITY HEALTH NURSING
GNM 3RD YEAR
UNIT-7

1. (COMMUNITY HEALTH NURSING) UNIT-VIII HEALTH TEAM Presented by : PURVI PATEL NURSING TUTOR MBNC

2. HEALTH TEAM Learning content : Health team Introduction Definition Concept Composition Functions

3. Role of nursing personnel at various levels District public health nursing officer Block health nurse Public health nurse Lady health visitors/health visitors Health worker female /ANM

4. INTRODUCTION

5. HEALTH TEAM

6. DEFINITION OF HEALTH TEAM

7. CONCEPT OF HEALTH TEAM

8. HEALTH TEAM CONSIST OF

9. CHARACTERISTIC OF HEALTH TEAM

10. HEALTH TEAM MEMBERS

11. PHYSICIAN/DOCTORS

12. SPECIALIST DOCTORS

13. PUBLIC HEALTH NURSES/STAFF NURSE

14. PHARMACIST

15. LAB TECHNICIAN

16. RADIOLOGIST

17. DIETICIAN

18. SOCIAL WORKERS

19. ADMINISTRATIVE STAFF

20. VOLUNTEERS WORKER

21. HEALTH TEAM AT PHC

22. MANPOWER CHC AT IPHS

23. HEALTH TEAM AT PHC

24. PHC MANPOWER

25. SUPPORTIVE MAN-POWER

26. SUB CENTRE MANPOWER

27. HEALTH TEAM CONCEPT Health Team Concept: Physician of today is overworked professionally. Many of the functions of the physician can be performed by auxiliaries, given suitable training. Auxiliary Worker: Is that one who has less than full professional qualifications in a particular field and is supervised by a professional worker. The practice of modern medicine has become a joint effort of many groups of workers,both medical and non- medical.

28. TYPE OF HEALTH TEAM

29. The team must have a leader. 1.Evaluate the team adequately. 2.Know the motivations of each member in order to stimulate and enhance their potentialities. Team leader should be able to:- Health team approach aims to produce the right “mix” of health personal for providing full health coverage of the entire population.

30. COMMUNITY HEALTH TEAM

31. PRIMARY HEALTH CENTRE

32. FUNCTION OF HEALTH TEAM

33. CONTINUE

34. Job Responsibilities of Health Assistant Female (LHV – Lady Health Visitor) (Female Supervisor)

35. Supervise and guide the Health Worker Female, Dais and guide ASHA in the delivery of health care service to the community. Strengthen the knowledge and skills of the Health Worker Female. Helps the Health Worker Female in improving her skills in working in the community. Helpandguidethe HealthWorkerFemaleinplanning and organizing her programmes of activities. Visit each Sub-Centre at least once a week on a fixed day to observe and guide the Health Worker Female in her day to day activities. SUPERVISION AND GUIDANCE

36. Assess fort nightly the progress of assessment report work of the Health Worker Female and submit with respect to their duties under various National Health Programmes. Carry out supervisory home visits in the area of the Health Worker Female with respect to their duties under various National Health Programmes. Supervise referral; of all pregnant women for RPR testing at PHC.

37. TEAM WORK Help the health workers to work as part of the health team. Coordinate her activities with those of the Health Assistant Male and other health personnel including the dais. Coordinate the health activities in her area with the activities of workers of other departments and agencies and attend meeting at PHC level. Conduct regular staff meetings with the health workers in coordination with the Health Assistant (Male). Attend staff meetings at the Primary Health Centre.

38. Assist the Medical Officer of the Primary Health Centre in the organization of the different health services in the area. Participate as a member of the health team in mass camps and campaigns in health programmes. Facilitate and Participate in activities of village Health & Nutrition Day.

39. SUPPLIES, EQUIPMENT AND MAINTENANCE OF SUB-CENTRES In collaboration with the Health Assistant Male, check at regular intervals the stores available at the Sub- Centre and help in the procurement of supplies and equipment. Check that the drugs at the Sub-Centre are properly stored and that the equipment is well maintained. Ensure that the Health Worker Female maintains her general kit, midwifery kit and Dai kit in the proper way. Ensure that the Sub-Centre is kept clean and is properly maintained.

40. RECORDS AND REPORTS Scrutinize the maintenance of records by the Health Worker Female and guide her in their proper maintenance. Review reports received from the Health Workers Female, consolidate them and submit monthly reports to the Medical Officer of the Primary Health Centre.

41. WHERE KALA-AZAR IS ENDEMIC, ADDITIONAL DUTIES ARE She will supervise the work of Health Worker Female during concurrent visit and will check whether the worker is performing her duties. She should check minimum of 10% of the house in a village to verify that the Health Worker Female really visited those houses ad carried her job properly. Her job of identifying suspected Kala- Azar cases and ensuring complete treatment has been done properly. She will carry with her the proper record forms, diary and guidelines for identifying suspected Kala-Azar cases.

42. She will be responsible along with Health Assistant Male for ensuring complete treatment of Kala- Azar patients in his area. She will be responsible along with Health Assistant Male for ensuring complete coverage during the spray activities and search operation. She will also undertake health education activities particularly through interpersonal communication, arrange group meetings with leaders and organizing and conducting training of community leaders with the assistance of health team.

43. WHERE JAPANESE ENCEPHALITIS IS ENDEMIC HER SPECIFIC DUTIES ARE AS BELOW She will supervise the work of Health Worker Female during concurrent visit and will check whether the worker is performing her duties. She should check along with minimum of 10% of the house in a village to verify that the Health Worker Female really visited those houses and carried her job properly. Her job of identifying suspected JE cases and ensuring complete treatment has been done properly.

44. She will carry with her the proper record forms, diary and guidelines for identifying suspected JE cases. She will be responsible for ensuring complete treatment of JE patients in her area. She will be responsible along with Health Assistant Male for ensuring complete coverage during the spray activities and search operation. She will also undertake health education activities particularly through interpersonalcommunication, arranging group meetings with leaders and organizing and conduction training of community leaders with the assistance of health team. •

45. TRAINING Organize and conduct training for Dais/ASHA with the assistance of the Health Worker Female. Assist the Medical Officer of the Primary Health Centre in conducting training programme for various categories of health personnel.

46. MATERNAL AND CHILD HEALTH Conduct weekly MCH clinics at each Sub-Centre with the assistance of the Health Worker Female and dais. Respond to calls from the Health Worker Female, the Health Worker Male, the health guides and the trained Dais and render the necessary help. Conduct deliveries when required at PHC level and provide domiciliary and midwifery services.

47. FAMILY WELFARE AND MEDICAL TERMINATION OF PREGNANCY She will ensure through spot checking that Health Worker Female maintains up-to date eligible couple registers all the times. Conduct weekly family planning clinics along with the MCH clinics at each Sub-Centre with the assistance of the Health Worker Female. Personally motivate resistant case for family planning. Provide information on the availability of services for medical termination of pregnancy and for sterilization. Refer suitable cases for MTP to the approved institutions.

48. Guide the Health Worker Female in establishing female depot holders for the distribution of conventional contraceptives and train the depot holders with the assistance of the health workers female. Provide IUCD services and their follow up. Assist M.O. PHC in organization of family planning camps and drives.

49. NUT R ITION Ensure that all cases of malnutrition among infants and young children (0-5 years) are given the necessary treatment and advice and refer serious cases to the Primary Health Centre. Ensure that iron and folic acid vitamin A are distributed to the beneficiaries as prescribed. Educate the expectant mother regarding breast feeding.

50. UNIVERSAL IMMUNIZATION PROGRAMME Supervise the immunization of all pregnant women and children (0-5 years). She will also guide the MPW (M) and MPW(F) to procure supplies organize immunization camps provide guidance for maintaining cold chain, storage of vaccine, health education and also in immunizations. Supervise the immunization of all pregnant women and infants. Follow the directions given in Manual of Health Worker (female) under National Immunization Programme.

51. ACUTE RESPIRATORY INFECTION Ensure early diagnosis of pneumonia cases. Provide suitable treatment to mild/moderate cases of ARI. Ensure early referral in doubtful/severe cases.

52. SCHOOL HEALTH Assist Medical Officer in school health services.

53. PRIMARY MEDICAL CARE Ensure treatment for minor ailments, provide ORS & First Aid for accidents and emergencies and refer cases beyond her competence to the Primary Health Centre or nearest hospital.

54. HEALTH EDUCATION Carry out educational activities for MCH, Family Welfare, Nutrition and Immunization, Control of blindness, Dental care and other National Health Programmes like leprosy, Tuberculosis and NCD programmes with the assistance of the Health Worker Female. Arrange group meetings with the leaders and involve them in spreading the message for various health programmes. Organize and conduct training of women leaders with the assistance of the Health Worker Female. Organize and utilize Mahila Mandal, Teachers and other women in the Community in the family welfare programmes, including ICDS personnel.

55. JOB FUNCTIONS OF HEALTH WORKER FEMALE (ANM) She will carry out the following functions: She will carry out all the activities related to various programs in a integrated manner when visiting the village/households

56. MATERNAL AND CHILD HEALTH 1.Register and provide care to pregnant women throughout the period of pregnancy. Ensure that every pregnant woman makes at least 4 (Four) visits for Ante Natal Check-up including Registration. Suggested schedule for antenatal visits 1st visit: Within 12 weeks—preferably as soon as pregnancy is suspected—for registration of pregnancy and first antenatal check-up However, even if a woman comes late in herpregnancy for registration, she should be registered, and care given to her according togestational age.

57. 2nd visit: Between 14 and 26 weeks 3rd visit: Between 28 and 34 weeks 4th visit: Between 36 weeks and term Provide ante natal check ups and associated services such as IFA tablets, TT immunization etc.

58. 2. Test urine of pregnant women for albumin and sugar. Estimate haemoglobin level. 3. Refer all pregnant women to PHC/CHC for RPR test for syphilis and Blood grouping. 4. Refer cases of abnormal pregnancy and cases with medical and gynaecological problems to Health Assistant Female (LHV) or the Primary Health Centre.

59. 5. Conduct deliveries in Sub-centre, if facilities of a Labour room are available and in her area when called for. 6. Supervise deliveries conducted by Dais and assist them whenever called for. 7. Refer cases of difficult labour and newborns with abnormalities, help them to get institutional care and provide follow up to the patients referred to or discharged from hospital.

60. 8. ANM will identify the ultimate beneficiaries, complete necessary formalities and obtain necessary approvals of the competent authority before disbursement to the beneficiaries under Janani Suraksha Yojana (JSY) and by 7th of each month will submit accounts of the previous month in the prescribed format to be designed by the State. ANM will prepare a monthly work schedule in the meeting of all accredited workers to be held on every 3rd Friday of every month, which is mandatory. The guideline under JSY is to be followed. In addition ANM will take weekly/fortnightly meetings with all ASHAs of her area to guide and monitor them.

61. 9. Tracking of all pregnancies by name for scheduled ANC/PNC services. 10. Make post- natal home visits on 0, 3, 7 and 42 nd day for deliveries at home and Sub-centre and on 3, 7, and 42nd day for institutional delivery. Post-natal visits are to be made for each delivery happened in her area and she should render advice regarding care of the mother and care and feeding of the newborn.

62. 11. In case of Low Birth weight Baby, a total of six post natal visits are to be made on 0, 3, 7, 14, 21 and 28th day to screen for congenital abnormalities, assess the neonate for danger signs of sickness etc. as per IMNCI guidelines and appropriate referral. 12. Initiation of early breast-feeding within one hour of birth, exclusive breastfeeding for 6 months and timely weaning at 6months as per Infant and Young Child Feeding Guidelines.

63. 13.Assess the growth and development of the infants and under 5 children and make timely referral. 14. Provide treatment for all cases of Diarrhoea,acute respiratory infections (pneumonia) and other minor ailments and refer cases of severe dehydration, respiratory distress, infections,severe acute malnutrition and other serious conditions as per IMNCI guidelines/National Guidelines.

64. 15. Educate mothers individually and in groups in better family health including maternal and child health, family planning, nutrition, immunization, control of communicable diseases, personal and environmental hygiene. 16. Assist Medical Officer and Health Assistant (Female) in conducting antenatal and postnatal clinics at the Sub-centre.

65. FAMILY PLANNING 1. Utilize the information from the eligible couple and child register for the family Planning programme. She will be squarely responsible for maintaining eligible couple registers and updating at all times. 2. Spread the message of family planning to the couples and motivate them for family planning individually and in groups. 3. Distribute conventional contraceptives and oral contraceptives to the couples, provide facilities and to help prospective acceptors in getting family planning services, if necessary, by accompanying them or arranging for the Dai/ASHA to accompany them to hospital.

66. 4. Provide follow-up services to female family planning acceptors, identify side effects, give treatment on the spot for side effects and minor complaints and refer those cases that need attention by the physician to the PHC/ Hospital. 5. IUCD insertion can be done by a trained ANM. 6. Establish female depot holders, help the Health Assistant (Female) in training them, and provide a continuous supply of conventional contraceptives to the depot holders. 7. Build rapport with acceptors, village leaders, ASHA, Dais and others and utilize them for promoting Family Welfare Programme. 8. Identify women leaders and train them with help of the Health Assistant (Female). 9. Participate in Mahila Mandal meetings and utilize such gatherings for educating women in Family Welfare Programme.

67. Medical Termination of Pregnancy 1. Identify the women requiring help for medical termination of pregnancy and refer them to nearest approved institution. 2. Educate the community of the consequences of unsafe abortion methods and septic abortion; inform them about the availability of services for medical termination of pregnancy.

68. Nutri t ion 1. Identify cases of Low Birth weight, malnutrition among infants and young children (zero to five years), give the necessary treatment and advice and refer serious cases to the Primary Health Centre. 2. Distribute Iron and Folic Acid tablets as prescribed to pregnant women, nursing mothers, adolescent girls and syrups to young children (up to five years), as per the national guidelines. 3. Administer Vitamin A solution to children as per the guidelines. 4. Educate the community about nutritious diet for mothers and children. 5. Coordinate with Anganwadi Workers.

69. Universal Programme on Immunization (UIP) 1. Immunize pregnant women with tetanus toxoid. 2. Administer DPT vaccine, oral poliomyelitis vaccine, measles vaccine and BCG vaccine to all infants and children, (Hepatitis B in pilot areas) as per immunization schedule. 3. Ensure injection safety, safe disposal and record, report and manage minor & serious Adverse Event Following Immunization (AEFI). Submit monthly UIP reports, weekly surveillance reports (AFP, Measles under IDSP). Serious AEFI and outbreakshould be reported immediately. 4. ANM is responsible for cold chain maintenance for vaccines during fixed and outreach sessions. 5. Manage waste generated during immunization as per GOI/CPCB guidelines. 6. Preparing work plan, estimating beneficiaries and logistics, preparing due list of expected beneficiaries in coordination with Angan wadi worker and ASHA/mobilizer on the session day and ensure their vaccination through adequate mobilization.

70. 7. Maintain Tracking Bag/Tickler box at each Sub centre, file updated counterfoils and utilize them for follow up. 8. Tracking of dropouts and left outs, records/ reports (including MCH register and immunization card counterfoils), surveillance/reporting Vaccine Associated Paralytic Poliomyelitis (VAPP) and AEFI incidents in catchment area. 9. Indent order of vaccines and logistics should be weekly based on the due beneficiary list. HW/Alternate Vaccinator should receive the required quantity of vaccine and logistics on the day of Immunization and supply to the session site. 10. Work plan indicating village, place, date & time of organizing proposed session, including the names of ASHA and AWW must be displayed at each Sub- centre. 11. Posters/Paintings on key messages, Immunization schedule, Positioning during vaccine administration, Safe Injection Practices, VVM,AEFI awareness, use of Hub cutters. 12. Village-wise dropout list for display at Sub-centre 13. Norm for due beneficiaries: 3 per session.

71. Communicable Diseases 1. Notify the MO, PHC immediately about any abnormal increase in cases of diarrhoea/dysentery, fever with rigors, fever with rash, flaccid paralysis of acute onset in a child <15 years (AFP), , Tetanus, fever with jaundice or fever with unconsciousness, minor and serious AEFIs which she comes across during her home visits, take the necessary measures to prevent their spread, and inform the Health Assistant (Male)/LHV to enable him/her to take further action. 2. HIV/STI Counseling, HIV/STI screening after receiving training. 3. Leprosy Impart Health Education on Leprosy and its treatment to the community. Refer suspected new cases of leprosy and those with complications to PHC. Provide subsequent doses of MDT to patients Ensure regularity and completion of treatment and assist health supervisor in retrieval of absentee/defaulter. Update the case cards at Sub-centres & treatment register at sector PHC. Assist leprosy disabled people in self care practices, monitor them and refer them to PHC when ever required.

72. Assi s t the Healt h W or k er (M a l e ) i n m a i nt ain i n g a record of cases in her area, who are under treatment for malaria, tuberculosis and leprosy, and check whether they are taking regular treatment, motivate defaulters to take regular treatment and bring these cases to the notice of the Health Worker (Male) or Health Assistant (Male). Give Oral Rehydration solution to all cases of diarrhea/dysentery/vomiting. Identify and refer all cases of blindness including suspected cases of cataract to M O, PHC.

73. Education, Counselling, referral, follow-up of cases of STI/RTI, HIV/AIDS. Malaria She will identify suspected malaria fever cases during ANC or Immunisation Clinic and home visits, and will make blood smears or use RDt for diagnosis of Pf malaria. to advise seriously ill cases to visit PHC for immediate treatment. All the fever cases with altered sensorium must be referred to PHC/District Hospital. the cases will be referred after collection of blood smear and performing RDt. to arrange transportation for such patients from home to the PHC/District Hospital. to contact all ASHAs/FtDs of the area during visit to the village and collect blood smears for transportation to laboratory. to cross verify their records by visiting patients diagnosed positive between the previous and current visit. to provide treatment to positive cases as per the drug policy. to replenish the stock of micro slides, RDks and/or drugs to ASHAs/FtDs wherever necessary. to keep the records of blood smears collected and patients given anti- malarial treatment. t o ens u r e ear l y diagn o s i s & r adi c al t r e a tme n t o f the diag n osed positive cases (PV & PF) compliance of Radical

74. Where Filaria is endemic: Identification of cases of lymphoedema/ elephantiasis and hydrocele and their referrals to PHC/CHC for appropriate management. training of patients with lymphoedema/ elephantiasis about care of feet and home based management remedies. Identification and training of drug distributors including ASHAs and Community Health Guides for mass drug distribution of DEC + Albendazole on National Filaria Day.

75. Where kala-Azar is endemic: From each family She shall enquire about the presence of any fever cases having a history of prolong fever more than 15 days duration in a village during her visit. She will refer such cases to the nearest PHC for clinical examination by the Medical Officer and confirmation by RDk. She shall take the migratory status of the family/guest during last three months. She will also follow up and persuade the patients to ensure complete treatment. She will keep a record of all such cases and shall verify from PHC about their diagnosis during the monthly meeting or through health supervisor during her visit. She will carry a list of all kala-azar cases in her area for follow up and will ensure, administration of complete treatment at PHC. She will assist the male health worker in supervision of the spray activities. She will conduct all health education activities particularly through inter-personal communication by carrying proper charts etc. for community awareness and their involvement.

76. Where Dengue/Chikungunya is endemic From each family She shall enquire about the presence of any fever case having rash and joint pain a village during her visit. She will refer such cases to the nearest PHC for clinical examination by the Med Officer and for laboratory confirmation by sending blood sample to the nearest Sentinel Surveillance hospital. She will supervise the source reduction activities in her area including at the time of observance of anti-Dengue month She will coordinate the activities carried out by Village Health Sanitation and Nutrition Committee. She will conduct health education activities particularly throughinter-personal communication by carrying proper charts etc. for social mobilization and community awareness to eliminate source of Aedes breeding and also guide the community for proper water storage practices .

77. Where JE is endemic: From each family She shall enquire about the presence of any fever case having encephalitis presentation. She will refer such cases to the nearest PHC for early diagnosis and management of such cases. She will conduct health education activities particularly through inter-personal communication by carrying proper charts etc. for social mobilization and community awareness for early referral of cases.

78. Non-Communicable Diseas es IEC Activities for prevention and early detection of hearing impairment/deafness in health facility, community and schools, harmful effectsof tobacco, mentalillnesses, Iodine Deficiency Disorders (IDD), Diabetes, CVD and Strokes. House to House surveys to detect list & refer cases of hearing & visual impairment and (along with annual survey register/enumeration survey. Minimum is annual survey, desirable to be done twice yearly subject to availability of second ANM). •Sensitization of ASHA/AWW/PRI about prevention and treatment of deafness. •Mobilizing community members for screening camps and assisting in conduction of screening camps to identify hearing or visual impairment cases if needed. •Motivation for quitting and referrals to Tobacco Cassation Centre at District Hospital. •Sensitization of ASHA/AWW/PRI about the Noncommunicable diseases. •Identification and referral of carer of common mental illnesses and Epilepsy for treatment and follow them up in community .

79. Greater participation/role of Community for primary prevention of NCD and promotion of healthy lifestyle. •Ensuring regular Testing of salt at household level for presence of Iodine through Salt Testing Kits by ASHAs. In Fluorosis affected districts IEC to prevent Fluorosis. Identify the persons at risk of Fluorosis, suffering from Fluorosis and those having deformities due to Fluorosis. Line listing, source reduction activities,reconstructive surgery cases, rehabilitative intervention activities, focused local action and referral of what is not possible locally. •Promoting formation and registration of Self Health Care Group of Elderly Persons’.

80. Oral Health education especially to antenatal and lactating mothers, school and adolescent children, first aid and referral for cases of oral problems. •Health communications on Disability, Identification of Disabled persons and their appropriate referral.

81. Vital Events Record and report to the health authorities the vital events including births and deaths, particularly of mothers and infants in her area.

82. Record Keeping 1. Maintenance of all the relevant records concerning mothers, children and eligible couples in her area. 2. Register (a) pregnant women at earliest contact (b) infants zero to one year of age (c) women aged 15-44 years (d) Under and above five children (e) Adolescents. 3. Maintain the pre-natal and maternity records and child care records. 4. Prepare the eligible couple and child register and maintaining it up-to-date. 5. Maintain the records as regards contraceptive distribution, IUD insertion. Couples sterilized, clinics held at the Sub-centre and supplies received and issued. 6. Prepare and submit the prescribed weekly/ monthly reports in time to the Health Assistant (Female). 7. While maintaining passive surveillance register for malaria cases, she will record: No. of fever cases No. of blood slides prepared No. of malaria positive cases reported No. of cases given radical treatment

83. 1. Provide treatment for minor ailments, first- aid for accidents and emergencies and refer cases beyond her competence to the Primary HealthCentre/Community Health Centre or nearest hospital. 2. Provide treatment as per AYUSH* as needed at the local level. Treatment of Minor Ailments

84. Team Activities 1. Attend and participate in staff meetings at Primary Health Centre/Community Development Block or both. 2. Coordinate her activities with the Health Worker (Male) and other health workers including the Health volunteers/ASHA and Dais. 3. Coordinate with PRI and Village Health Sanitation and Nutrition Committee. 4. Draft annual Village Health Plan with the help of Health Worker (Male), PRI and VHSC for submitting the same to block. 5. Meet the Health Assistant (Female) each week and seek her advice and guidance whenever necessary. 6. Maintain the cleanliness of the Sub-centre. 7. Dispose medical waste as per the IMEP guidelines, of GOI. 8. Organize, participate and guide in organizing the VHN Days at Anganwadi Centers. 9. Participate as a member of the team in camps and campaigns.

85. House-to House Surveys These surveys would be done once in April annually. Some of the diseases would require special surveys- but at all times not more than one survey per month would be expected. Surveys would be done with support and participation of HW (male), ASHAs, Anganwadi Workers, community volunteers, panchayat members and Village Health Sanitation and Nutrition Committee. Other details are given on page no. 11.

86. These surveys would be done once annually, preferably in April. Some of the diseases would require special surveys- but at all times not more than one survey per month would be expected. Surveys would be done with support and participation of ASHAs, Anganwadi Workers, community volunteers, panchayat members and Village Health Sanitation and Nutrition Committee members. The Male Health worker would take the lead and be accountable for the organization of these surveys and the subsequent preparation of lists and referrals. The surveys would include.

87. Esse n tial Age and sex of all family members. •Assess and list eligible couples and their unmet needs for contraception. •Identify persons with skin lesions or other symptoms suspicious of leprosy and refer: essential in high leprosy prevalence blocks. •Identify persons with blindness, list and refer: Identify persons with hearing impairment/ deafness, list and refer. •Annual mass drug administration in filaria endemic areas.

88. Desirable Identify persons with disabilities, list and refer and call for counselling where needed. •Identify and list senior citizens who need special care and support. •Identify persons with mental health problems and Epilepsy; list and refer. •In high endemicity areas-survey for fever suspicious of kala- azar, for epidemic management of malaria, for detection of fluorosis affected cases etc. •Any other obvious disease/disorder; list and refer.

89. Role of ANM as a Facilitator of ASHA Auxiliary Nurse Midwife (ANM) will guide ASHA in performing the following activities: She will hold weekly/fortnightly meeting with ASHA and discuss the activities undertaken during the week/fortnight. She will guide her in case ASHA had encountered any problem during the performance of her activities. •ANM will act as a resource person for the training of ASHA. •ANM will inform ASHA regarding date and time of the outreach session and will also guide her for bringing the beneficiary to the outreach session •ANM will participate and guide in organizing the Health Days at Anganwadi Centres. •She will take help of ASHA in updating eligible couple register of the village concerned.

90. She will utilize ASHA in motivating the pregnant women for coming to sub- centre for initial checkups. ASHA will also help ANMs in bringing married couples to Sub-centres for adopting family planning methods. •ANM will guide ASHA in motivating pregnant women for taking full course of IFA Tablets and TT injections etc. •ANMs will orient ASHA on the dose schedule and side affects of oral pills. •ANMs will educate ASHA on danger signs of pregnancy and labour so that she can timely identify and help beneficiary in getting further treatment.

91. ANMs will inform ASHA on date, time and place for initial and periodic training schedule. She will also ensure that during the training ASHA gets the compensation for performance and also TA/DA for attending the training. •Train in Salt Testing using salt Testing Kits. The second ANM will follow similar job responsibilities as the above. It is to be ensured that one ANM out of the two is available at the Sub-centre. Other ANM will perform the field duties. The time schedule for their turn visits be prepared with the approval of the Panchayats involved.

92. PUBLIC HEALTH NURSE JOB DUTIES: Serves patients by visiting homes; determining patient and family needs; developing health care plans; providing nursing services and treatments; referring patients with social and emotional problems to other community agencies. Helps the community health care team by coordinating assessment, planning, and providing of needed health and related services; participating in case conferences with physicians, hospital and rehabilitative personnel, and representative of other agencies. Provides health information by instructing family in care and rehabilitation of patient; maintaining health and prevention of disease for family members; teaching home nursing, maternal and child care; providing instructions in other subjects related to individual and community welfare.

93. Safeguards health of children by participating in child health conferences, school health; providing group instruction for parents; conducting immunization programs. Arranges convalescent and rehabilitative care of sick or injured persons by cooperating with families, community agencies, and medical personnel. Improves quality results by studying, evaluating, and recommending changes in processes; implementing changes. Keeps vehicle and equipment operating by following operating instructions; troubleshooting breakdowns; maintaining supplies; performing preventive maintenance; calling for repairs.

94. Keeps vehicle and equipment operating by following operating instructions; troubleshooting breakdowns; maintaining supplies; performing preventive maintenance; calling for repairs. Keeps supplies ready by inventorying stock; placing orders; verifying receipt. Documents actions by completing forms, reports, logs, and patient records. Avoids legal challenges by complying with legal requirements; keeping patient information confidential.

95. Updates public health job knowledge by participating in educational opportunities; reading professional publications; maintaining personal networks; participating in professional organizations. Enhances public health department and city reputation by accepting ownership for accomplishing new and different requests; exploring opportunities to add value to job accomplishments.

96. Public Health Nurse Skills and Qualifications: Verbal Communication, Health Promotion and Maintenance, Listening, Quality Management, Energy Level, Integrity, Infection Control, Informing Others, Nursing Skills, Medical Teamwork, Multi-tasking Minimum qualification GNM/B.sc(N) State registration council

97. PUBLIC HEALTH NURSE SUPERVISOR

98. DUTIES AND RESPONSIBILITIES OF BLOCK EXTENTION EDUCATOR

99. The Block Extension Educator is the kind pin for organizing Information, Education Communication activities relating to Health and Family Welfare Programme in the Primary Health Centre/ Block Area. He would be under the immediate administrative Control of the Medical Officer of the Primary Health Centre and he will function under the technical supervision and guidance of the District Mass Education and Information Officer. His main functioning would relate to the promotion of Health and Family Welfare Programme. He will consult District health Officer in formulating the special programme for his Primary Health Centre

100. Duties and Functions Identify the educational needs related to various Maternity and child Health and Family Welfare Programmes in the Primary Health Centre, area. 2. Collect all information relating to Maternity and Child Health and Family Welfare and prepare plan for I.E.C. activities in consultation with the Medical Officer, Primary Health Centre, and 3. Form Health Committee at Village level to enlist co-operation of the opinion leader especially women for Maternity and child Health and Youths Family Welfare, Family Welfare Media Programme once a Month (i.e) 12 meetings per year.

101. Procure maintain and maximum use of mass Media equipments. 5. Maintain records of IEC activities, tour programmes daily diaries and other registers and ensure preparation and display of relevant maps and charts in the Primary Health Centre. 6. Maintain liaison with District Bureau to procure regular and adequate supply of IEC materials and contraceptives and ensure proper distribution and ensure availability with each and every health staff, namely M.P.H.W (F) and Male Workers and Male Supervisors ensure display of materials at each sub- centre.

102. Establish working relationship with the Block Development Officer and enlist his staff’s co-operation in the implementation of Maternity and Child Health and Family Welfare Programme. 8. Co-ordinate with Education Department. Nehru Yuva Kendra, Social Welfare Department. Agriculture Industrial Department etc., for promoting family welfare and MCH Scheme. 9. He should participate all the function and festivals conducted in the Block areas and conduct propaganda and publicity on Family Welfare Scheme. 10. He will be member of the Local Block Level Family Welfare Committee and act as a resource person. 11. Organise Mass Media Programme, Mini-exhibitions. Film shows, Cultural programmes weekly/Monthly celebrations and IEC programmes at local fairs on market day etc., utilising Audio Cassettes.

103. Work with industrial/factories and other Government and Non-Government agencies to strength IEC activities relates to Maternity and Child Health and Family Welfare. 13. Use various approaches (individual. group and Mass) to popularize Maternity and Child Health and Family Welfare Programme among rural people. 14. Organise Educational Programmes for formal and non-formal (out of school) groups on population education and health measures. 15. Co-ordination with animators of Adult Education Department in organising learners classes. 16. Co-ordinate activities with Service Organisations like Rotary/Lions/Jacess/LPG distributors etc 17. Organise short Orientation Training Camps/Educational Programme for various voluntary agencies and other target groups.

104. Conduct Family Welfare Leaders Camps. 19. Use opinion leaders, satisfied customers and secure credible Persons to bring out recording news letters etc., 20. Organising service Training for Lady Health Visitors and Multi Purpose Health Workers on IEC. 21. Organise short orientation training on IEC for supportive staff such as private Medical Practitioners, teachers, Social /communicators, Sanitary Workers, Adult Education Supervisors, Animators and ICDS workers. 22. Prepare talking points in relation to educational activities carried out in the Primary Health Centre Area. 23. Provide guidance to field staff in IEC activities related to Maternity and Child Health and Family Welfare.

105. Work with all the Co-operative Society members; provide M a le st a f f t o vi s it Co - ope r a ti v e soci e ti e s r egula r l y . Supply them Nirodh, Organised Training and discussions for members various Co-operative societies. 25. He will review youth club and organize their activities. He will review the woman’s club and organize its activities. 26. He will organize special Health campaigns in the event of any epidemic or out break of any diseases. 27. He will propagate preventive aspects of health through the Health Staff and promote hygiene and sanitation in the Village.

106. Conduct periodical evaluations to study the impact of IEC. 29. Tour for 15 days in a month for the purposes for inspections and conducting field programmes. 30. He should submit monthly reports on Mass Education and Extension education activities of Primary Health Centre, before 10 th of every month to district Family Welfare, Maternity and Child Health Officer and copy to the district Mass Education and Information Officer.

107. DUTIES AND RESPONSIBILITIES OF THE POST OF COMMUNITY HEALTH NURSE INTRODUCTION 1.The Community Health Nurse shall work under the immediate control, guidance and supervision of the Medical Officer in-charge of the Block Primary Health Centre and over all-administrative, and technical control and supervision and guidance of the Deputy director of Health Services concerned. (2) She will supervise, control and guide the Female component of the Field Health Staff i.e., Sector Health Nurses (Multipurpose Health Supervisors (Female) and Village Health Nurse (i.e. Multipurpose Health Workers (Female). (3) The Female component of the Field Health Staff of the Primary Health Centres and Health Sub-centres of the Block shall work under the immediate technical control and supervision of the Community Health Nurse and over all administrative control of the medical Officer of the Primary Health Centre concerned.

108. (4) The community Health Nurse shall keep herself conversant with the villages, Topography and the demographic characteristics, health needs and demands and public health problems in the block area. (5) The Community Health Nurse is responsible to assist the Medical Officers of the Primary Health Centres concerned and thus ensure the performance and achievement by the Female component of the Field Health Staff of the Primary Health ‘centres and Health Sub-centres in respect of various Health Programmes are including Family Welfare Programme in the block area. She shall ensure that all the activities under various Health and Family Welfare Programmes are implemented by the Sector Health Nurses (i.e. Multipurpose Health Supervisors (Female) and Village Health Nurses (i.e. Multipurpose Health Workers (Female) in the area of their jurisdiction.

109. FUNCTIONS UNDER MATERNITY AND CHILD HEALTH SERVICES (1) She shall ensure rendering of Mother and Child Health care services such as pre-natal, inter natal, and postnatal care of mothers and infants and Pre-School child health care by and through the Female component of the Field Health Staff of the Primary Health Centres, Health Sub- Centres and Supervision of Services rendered by Dais. (2) She shall assist the Medical Officers of the Primary Health Centres and ensure by effective supervision in screening of high-risk cases of pregnancy and infants. Children by the Female component of the Field Health Staff for arranging for provision of special care and higher medical attention by referral to the appropriate higher treatment facility centres.

110. III. IMMUNISATION (1) She shall assist the Medical Officer, Primary Health Centre to Plan, organize and implement immunisation service under UIP as per the latest policy and National immunization Schedule and Sate Government instructions and ensure universal coverage of eligible beneficiary population in each village and Habitation in the block area thro’ the Female component of the Field Health staff of the Health Sub-Centres and Primary Health Centres by proper calendar of activities and visits. (2) She shall assist the Medical Officers, Primary Health Centres to ensure adequate supplies of vaccines i.e antigens and all equipments and items required for immunization services from time to time for the effective implementation of the immunization services in the Community. (3) She shall with the guidance and support of the Medical Officer, Primary Health Centre ensure proper storage of vaccines under optimum and prescribed temperature in Primary Health Centres in the field and she will inspect the cold chain equipments in all places and ensure continuous cold chain during transport of vaccines.

111. (4) She shall assist the Medical Officer, Primary Health Centre to investigate and report all adverse event, reactions and complications arising out of administration of immunization and arrange to undertake necessary remedial corrective measures as required under guidance and supervision of the Medical Officers of the Primary Health Centres. (5) She shall assist the Medical Officers of the Primary Health Centres and District Health authorized to plan, organize and implement services for effective administration of various nutrition programmes and administration of Vitamin-A solution and Iron and folic Acid supplementation to the eligible beneficiaries that the Female Field Health Staff. (6) She shall ensure that the Sector Health Nurses and Village Health Nurses of Primary Health Centres and Health Sub Centres visit all the TamilNadu Nutritious Noon Meal Programme Centres/Community Nutrition Centres and ICDS (Anganwadi) Centres in her area regularly and ensure provision of health care services including referral as per programme instructions to the children.

112. (7) She shall ensure that the periodic monitoring of the growth and development of children from the time of birth as carried out by Village Health Nurses and Sector Health Nurse at appropriate intervals and so that the Health cards and related records are maintained by concerned Field Health and Nutrition functionaries as per programme directives. (8) She shall assist the Medical Officer, Primary Health Centres in ensuring that all cases of maternal and infant and child deaths are investigated socio-epidemiologically and notified to higher authorities and arrange to undertake rendering of suitable preventive and remedial measures to prevent such mortality under the guidance and supervision of Medical Officers of Primary Health Centres and district Health Authorities. (9) She shall assist the Medical Officers to ensure conduct of regular surveillance by all the field Health Staff of the Primary Health Centers and Health Sub-Centres in respect of occurrence of the Vaccine preventable diseases in her block area and maintain Health Sub-Centre wise and Primary Health Centre wise account of all cases of vaccine preventable diseases in collaboration and coordination with Block Health supervisor (Male).

113. (10) She shall verify the stock position of all the items of equipments, syringes, needles and vaccines and ensure proper flow of materials and vaccines with little room for shortage or surplus. (11) She will maintain and ensure sterilization of syringes and needles and adoption of practice of one syringe. One needle for one child for each Immunisation administered by Field Health staff implementing immunization services both in the clinic and in the community.

114. FAMILY WELFARE (1) She shall be responsible to assist the Medical Officers of the Primary Health Centres for the successful and affective implementation of National Family Welfare Programme through the Female Health Staff of Primary Health Centres and Health sub- Centres in her block. (2) The Community Health Nurse is responsible for implementation of activities under information and Education on Family Welfare in collaboration with Block Extension Educator and motivation of staff and strengthen and supervision of Family Welfare Services and after care and follow-up. (3) She shall with the Female Health Supervisors i.e Sector Health Nurse arrange follow-up of Family Welfare cases and accepts of Family Welfare methods such as intrauterine device and oral pills etc. for immediate management and referral if any

115. SUMMARY Till now we discussed about health team like introduction, definition, composition, function of health team . Role of nursing personnel at various officers like district public health nursing officers, block health nurse, public health nurses , lady health visitors/health supervisor, health worker female/ANM.

116. Conclusion I hope you all understand the health team and their composition followed by function discussed various health workers like PHN,DPHNS,BHN, LHV/LHVS, HW(ANM) their role and responsibilities in health care services. If you got chance to work as a health team in various department will you able to all apply this knowledge with confidently.

117. Question related to topic? Define the health team? Enumerate the composition of health team? Discuss the function of health team? Explain in detail about district public health nursing officer? Describe the role and responsibilities of block health nurses Discuss the role and responsibilities of public health nurse? Describe the role and responsibilities of lady health visitors/health supervisor? Understand the role and responsibilities health worker female (ANM)?

118. BIBILIOGRAPHY STUDENT REFERENCE ? K.Park the text book of” preventive and social medicine” 24 th edition, jaypee brothers, new delhi. Page no. 846-856 IPHS standard for community health centre guidelines. IPHS standards for primary health centre IPHS standards for subcentre

119. TEARCHER REFERNCES? K.Park the text book of” preventive and social medicine” 24 th edition, jaypee brothers, new delhi. Page no. 846-856 IPHS standard for community health centre guidelines. IPHS standards for primary health centre IPHS standards for subcentre