DELIVERY OF COMMUNITY HEALTH SERVICES BSC 4 TH YR.pptx

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


Planning, Budgeting
and Material
Management of SCs ,
PHC and CHC


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


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


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.


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


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

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


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)


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


 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


 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


 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


 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


 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
Sub-centre


 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


 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


 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

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


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


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


 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


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


1. To provide comprehensive primary health
care to the community through the primary
health centres
2. To achieve and maintain an acceptable
3. To make the services more responsive and
Objectives of PHC


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:
1. 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

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


 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.


 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.


 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.


 Disease surveillance and control of
epidemics: Disinfection of water sources and
testing of water quality using H S Strip .
₂
 Training: Training of ASHA, health workers
and trained birth attendants, doctors on
emergency obstetric care.


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)


1. To provide optimal expert care to the
community.
2. To achieve and maintain an acceptable
3. To make the services more responsive and
Objectives of CHC


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.
CHC


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


1. Care of routine and emergency cases in
surgery: Surgery for hernia, hydrocele,
appendicitis hemorrhoids, fistula, etc. handling
of emergencies like intestinal obstruction,
hemorrhage.
2. 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.


3. Maternal Health (same as PHC
4. New-born Care and Child Health (same as
PHC).
5. Family Planning (same as PHC).
6. National health programmes communicable
and non communicable disease programme


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


1. Standard Surgical Set - I and II: Trays,
instruments/dressing material, gloves, surgeon
forceps backhaus, towel, sponge, holding
hemostatic, halstead mosquito, needles,
hypodermic, etc.
2. 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

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


6. Equipment for Neonatal Resuscitation:
Catheter, nasal catheter, endotracheal, stilette,
laryngoscope, lateral mask, resuscitator, lamp,
etc.t table.
7. 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


8. Equipment for Labour Room: Lamps, table,
trolley, torch, trays, vacuum extractor,
weighing machine for babies, wheel chairs,
etc.
9. 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


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


1. Eligible couple register including contraception.
2. 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


4. Drug Register.
5. Equipments , furniture and other accessories,
register communicable diseases/epidemic
register.
6. Register for water quality and sanitation.
7. Register for records Janani Suraksha Yojana
Records Maintained at
Health Centre


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


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


Rural organization at village
level
Village health guides
Anganwadi workers
Asha
Local Dai / TBA( Traditional birth
attendant )


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

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


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


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….


 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


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)


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….


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


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

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