MLHP.pptx.....................................

Roles and
responsibilities
of MLHP
Prepared by
Mrs. Krupa Mathew.M,
Professor

The concept of mid-level health providers started 100
years ago in many countries and showed a remarkable
change in their health indicators.
Since last 10 years, the growth of health professionals is
in rise with its new emerging roles.
Mid-level health care providers are new emerging
workforce in healthcare sector.
India is alarming country for disease burden and to cover
the huge gap in providing health care facilities, it
requires the mid-level health care providers at different
settings of the country.
Introduction
( MLHP/CHO/CHP )

In order to provide quality primary health care in 2019,
a new Mid-level Health Care Provider role was
introduced in India, also known as Community Health
Officer/ Community Health Provider.
The role was intended for support the health and
wellness centres in community
Mid-level practitioners, also called assistant practice
clinicians and non-physician practitioner, are trained
health care providers who have a defined scope of
practice

This means that they are trained and legally permitted to
provide healthcare in fewer situations than physicians and
some other health professionals, but more than other health
professionals.
Mid-level providers are cost-effective in primary care
settings, where they can relieve physicians of the necessity of
providing routine care.
Community health officers play a role to bridge the gap
between community people and health care facilities. The
services provided by them improve the quality of life in
community and also empowers the community health care
settings

According to WHO, Mid Level Health Provider is : A health
provider:
Who is trained, authorized and regulated to work
autonomously,
Who receives pre-service training at a higher education
institution for at least 2-3 years, and
Whose scope of practice includes (but is not restricted to)
being able to diagnose, manage and treat illness, disease and
impairments (including perform surgery, where appropriately
trained), prescribe medicines, as well as engage in
preventive and promotive care.
Definition

Studies reported around 11.5% households in rural
areas and about only 4% in urban areas, are not
receiving any form of OPD care at sub- centre,
primary health centre and CHC level.
This indicates the low utilization of primary health
care for minor ailments or it may be because of
inefficient health-care services or unavailability of
healthcare providers.
Need for MLHP

In order to expand access to comprehensive primary
health care (CPHC), government of India has
launched Ayushman Bharat - Pradhan Mantri Jan
Arogya Yojana (PMJAY) in Sept, 2018. PMJAY is a
centrally sponsored scheme.
Under this scheme - health and wellness centres
(HWCs), sub health centres (SHCs), and primary
health centres (PHCs) are being strengthened as
health and wellness centres (HWCs).

The services in HWCs will be provided through a mid-
level health care provider (MLHP)/community health
officer (CHO) placed at a HWCs and medical officer at
PHC (rural/urban).
The MLHP/CHO will undergo a certificate in
community health through IGNOU or public university
Community health officers are health care workers with
training less than that of a physician but greater than that
of more ordinary nurses and other medical assistants.

India is a second most populous nation in the world
and also a developing country.
 With this growing population, India is in a great
demand of doctors and nurses.
At present India has a shortage of an estimated
600,000 doctors despite of more than 529
government and private medical colleges having an
annual intake of 70,978 students

 CHO’s are permitted to serve the community independently to
diagnose, manage and treat minor ailments and impairments
and also engage in preventive Expended Service Delivery.
Continuum of Care – Tele-health/ Referral.
 Their expanding roles are more helpful for low- and middle-
income countries, as a strategy to overcome the shortage of
health care workforce challenges and improve access to
essential health care services.
 So, the MLHP or CHO or mid-level practioner (MLP) or
community health provider (CHP) are sounds the same and
ultimately it means the majority of nurses will be in this role.

TRAINING
MLHPs trained in a six-month IGNOU accredited
‘Certificate Program in Community Health” to build
competencies in public health and primary care theory, skill
and experimental earning.
It is a six months programme of 18 credits (8 credits in theory
and 10 credits in practical).
 It has 2 theory and 1 practical course.
The programme was designed and developed with the
funding of Ministry of Health and Family Welfare, GOI
(NHM) and the programme has been launched by IGNOU in
January, 2017.
 Nursing and AYUSH Practitioner are eligible

CHO roles and responsibilities are purely population oriented
in public health.
They are expected to provide specific service delivery,
leadership, supervision, management and take pro-active role
in all the activities at community level, organize various health
program and activity in health promotion according the need
These roles of CHO help to bridge the gap between health care
facilities and population seeking health care. Roles are:
1. Health care services
2. Administrative and supervision services
3. Other services
Roles and responsibilities of
MLHP

Maternal health care:
Prenatal care like antenatal checkup, screening for
high risk, immunization and supplementation, child birth,
postnatal care and if require referral to higher center.
Neonate and infant health care:
Management of high-risk newborn, screening of
congenital anomalies, IMNCI services, immunization.
Childhood and adolescent health care:
Adolescent health counselling, identification of
drug abuse, detection of any deficiency, nutritional
supplement and referral services.
Health care services

 Reproductive health care:
Family planning, prevention and management of STI,
identification of gynecological problems and referral services.
 Communicable diseases:
Diagnosis and treatment of vector or water borne diseases,
provision of DOTs and DPMR (disability prevention and medical
rehabilitation) services for leprosy along with referral services.
 Illness and minor ailments:
Identification and management of fever, respiratory infection,
diarrhea, cholera, skin rashes, pain, typhoid, etc.
 Non-communicable diseases:
Screening, prevention, control and management along with
follow up and maintenance of treatment modalities.

Eye and ENT:
Screening along with primary care of ophthalmic
and ENT problem and referral services of any emergency.
Oral health:
Regular checkup and screening of oral health.
Geriatric and palliative care:
Health camp organization routine checkup.
Emergency services:
Burn, injury, trauma along with first aid
management.
Mental health care:

 Administrative services:
Guidance to other co-health workers and maintain inventory,
report submission.
 Supervision:
Supervision of national health program, ASHA, home visits,
health promotion activities
 Care pathway:
Provide specific care according to standard treatment
guidelines.
 Case coordinator and manager:
Provide communication to higher authority regarding
specific case, coordinate in care and management of care.
Administrative and supervision services

 Disaster and outbreak of disease:
Local response to disease outbreak and early management of
disaster.
 Fund management:
Support the team for entitling the fund for various projects and
program.
 Data management:
Record population data with various health indicator and
communicate it.
 Environmental role:
Education to community, speak about safe water, sanitation,
disposal of waste, pollution control and identify environmental hazards
and control

Communication skills, interpersonal
relationship skills, transcultural competence,
assessment skills, training capability, professionalism,
advocacy, education and facilitation
Other services

• Since we have shortage of doctors and specialists, the shift in
role to mid-level health care provider will relieve the
overburdened doctors and specialists, at least in rural health
setting
• Mid-level health care provider has the limited licence only in
primary and preventive healthcare to practice medicine at
mid-level, who qualify the criteria as may be specified by
regulations which will have an overwhelming representation
of doctors.
• This initiative by government of India will help to provide
easy and affordable health care services to the population
which also play an important role for universal health
coverage in India.
Conclusion

1. World Health Organization, Global Health Workforce
Alliance. The Kampala Declaration and Agenda for Global
Action. Geneva: WHO; 2008.
2. International Labour Organization. The International
Standard Classification of Occupations (ISCO-88). Geneva:
ILO; 2004.
3. World Health Organization, Western Pacific Region. Mid-
level and nurse practitioners in the Pacific: models and
issues. Manila: WHO/WPRO; 2001
4. Desai S et al. Int J Community Med Public Health. 2020
Apr;7(4):1610-1617
REFERENCES

MLHP.pptx.....................................

MLHP.pptx.....................................

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