Phc visit

VISIT TO A P.H.C / C.H.C

Dr. Indrajeet KumarTutor, Department of P.S.M

NATIONAL LEVEL HOSPITALS

REGIONAL HOSPITALSAIIMS, IGIMS

STATE LEVEL HEALTH ORGANIZATIONS

Medical Colleges

DISTRICT HEALTH ORGANIZATIONS

SUB. DISTRICT / TALKAS HOSPITALS

COMMNITY HEALTH CENTRES(1 : 1,00,000 in Plains, 1 : 80,000 in tribal / Hilly areas)

PRIMARY HEALTH CENTRES 1 : 30,000 (Plains), 1 : 20,000 (Tribal / Hilly areas)

SUB – CENTRES1 : 5000 (Plains), 1 : 3000 (Tribal / Hilly areas)

VILLAGE LEVEL 1 : 1000 Population

Anganwadi worker, Birth attendant, Health guide, link worker (ASHA)

HEALTH CARE DELIVERY SYSTEMOR

LEVELS OF HEALTH CARE

PR

IMA

RY

HEA

LTH

CA

RE

SEC

ON

DA

RY

HEA

LTH

CA

RE

TER

TIA

RY

HEA

LTH

CA

RE

What to see……….

• 1. Name of the place & it’s location

• 2. Population covered by it.

• 3. Number of sub-centre & PHC(addl.PHC) under it.

• 4. Infra-structure.(OPD room, indoor 6/30 beds, O.T, labor room, lab., store etc.)

• 5. Manpower.

• 6. Services provided (Functions)

Staffing Pattern of C.H.C

PERSONNEL Existing Strength Strength as per IPHS Qualification

Block Health officer - - Sr. most specialist

General Surgeon 1 1 MS / DNB General Surgery

Physician 1 1 MD / DNB General Medicine

Obstetrician & Gynaecologist 1 1 MD / DNB / DGO Obs. & Gyn.

Paedetrician 1 1 MD (Paed) / DNB (Paed./ DCH

Anaesthetist 1 MD (Anaes.)/DNB/ D.A/ 1yr. Cert. course in anaesth.

Public Health manager 1 MD(PSM) / MD(CHA) / P.Gdegree with MBA

Eye Surgeon 1 / 1 for every 5 CHC MD/ MS/DNB (Ophthalmology)

Dental Surgeon 1 BDS

General Duty M.O 6 ( at least 2 female doctors) MBBS

Specialist of Ayush 1 P.G in AYUSH

General duty M.O AYUSH 1 Graduate in AYUSH

TOTAL 4 15 / 16

Support Manpower

Personnel Existing As per IPHS

Staff Nurse 7 + 2(1ANM & 1PHN for FW appointed under the ASHA scheme)

19

Public Health Nurse (PHN) 1 ( appointed under ASHA scheme)

ANM 1 (Appointed under ASHA Scheme)

Pharmacist / Compounder 3

Pharmacist – AYUSH 1

Lab – technician 1 3

Radiographer 1 2

Ophthalmic Assistant 0 -1 1

Dresser(certified by Red Cross / St. Johns ambulance) 1 2

Ward Boys / Nursing Orderly 2 5

Sweeper 5

Chowkidar 3 5

Dhobi 1

Mali 1

Aya 5

Peon 2

OPD Attendant 1

Registration Clerk 2

Statistical Assistant / Data Entry Operator 0-1 (Flexible as per requirement) 2

Accountant Admin. Assistant 1

OT Technician 1

TOTAL 21 – 22 +2 64

Functions of Community Health Centre

• To provide specialist services (routine and emergency cases in surgery, medicine, obs & gyn. and Paediatrics) .

• Indoor patient care (30 beds are available).

• RCH services.

• Services for National Health Programmes.

• Cold chain maintenance through ILR and deep-freezers, cold boxes, and day carriers.

• Laboratory and x-ray services.

• Blood storage facility.

• Referral Services

• Training and continuing education of health teams.

• Information, education and communication (IEC)activities for specific problems.

• To elicit community participation.

• To enhance public private partnership(PPP).

Services for National Health Programmes

• RCH (Reproductive and Child Health).

• National Immunization Programme (UIP)

• Janani Suraksha Yojna (JSY).

• Polio Eradication Programme.

• RNTCP (Revised National Tuberculosis Programme) .

• National Malaria Control Programme. National Vector Borne Disease

• National Filaria Control Programme. Control prog.

• National leprosy Eradication Programme (NLEP)

• National Programme for control of Blindness

RCH I & II (Reproductive & Child Health)

• Services for Mother: a. Essential Obstetric Care - early registration : at least 3 ANC

- provision of safe delivery : 3 post-natal checkups.b. Emergency Obstetric Care ( strengthen FRUs with emergency

obstetric kit, equipment kit & skilled manpower)

c. 24 X 7 Delivery Services.d. Medical Termination of Pregnancy.e. Control of reproductive Tract Infection (RTI) & Sexually

Transmitted diseases (STD/STI)Services for Child:- a. immunization.

b. Essential New born Care ( to reduce PMR & NMR) facility:- Resuscitation of new born with asphyxia.:- Prevention of hypothermia.:- Prevention of infection.:- Exclusive breast feeding.:- Referral of sick.:- Train M.O in such care.

c. Oral rehydration therapy.d. Acute Respiratory Disease Control.e. Prevention & control of vitamin A deficiency in children. 5 doses of vit A to

children between 9m to 3yrs (9m – 16m – then 3 doses every 6m)

DISPOSABLE DELIVERY KIT (DDK)

CONTENTS OF DISPOSABLE DELIVERY KIT :- Cleanliness during intra natal care:-Plain Polythene sheet 75 x 75 cm 1pc clean surface for deliverySoap (carbolic) 1pc clean hands & fingernailsCotton 2.5gm X 2gm 2pcCotton Thread (10No) 30cm 3pc clean threadGauge 10cm x 10cm 4pcStainless steel Blade (ISI) 1pc clean blade

clean cord, keeping birth canal clean by avoiding harmful

practices.

VITAMIN- A PROPHYLAXIS

• Every child between 9m – 3yrs of age given 5 doses of vitamin A.

• 1st dose at 9month 1,00,000 IU or 1ml

along with measles vaccine.

• 2nd dose at 16month 2,00,000 IU or 2ml

along with booster of DPT.

• 3rd dose after 6month 2L IU

• 4th dose after 6month 2L IU

• 5th dose after 6month 2L IU

NATIONAL IMMUNIZATION PROGRAMME (UIP)To prevent the 6/7 vaccine preventable diseases . Points to be noted are:-

a. Cold Chain equipments:- Walk in Cooler (WIC)Deep Freezer 300/140LIce lined Refrigerator (ILR) 300/240L

Cold BoxesVaccine Carrier (x)Day carrier

b. Vaccines , Diluent & VVM (vaccine Vial monitor)c. AD syringe (auto Disabled syringe)d. Hub cutter. e. Disposal of used syringes.

Heat sensitive colour monitors which change colour on exposure to heat

Janani Suraksha Yojana (JSY)

Aim is to:-

:-Reduce MMR(212 / 1,00,000 live birth) & IMR (44/100 live birth )

:- Increase Institutional delivery in BPL families.

• Target Group:-

:- all pregnant lady of BPL family of age 19yrs or more & married.

:- up to two live birth*.

In JSY to promote institutional delivery cash benefit / assistance has been linked to institutional delivery. Incentive is given to ASHA ( Rs.600) and Pregnant lady (Rs.1400).

Revised National Tuberculosis Control Programme (RNTCP)

• Provide Diagnostic Services through the Microscopy Centre which

are established in the CHC (1per 1,00,000Population).

• Provide treatment services by providing DOTS as per technical

guidelines.

• Treatment of common complications of TB and side effect of drugs.

• Record and report on RNTCP activities as per guidelines.

National Malaria Control Programme (NMCP)under NVBDC prog

• Provide diagnostic and treatment facility for routine and complicated cases of Malaria, Filaria, Degue, Japanese Encephalitis and Kala-azar in the respective endemic zone.

• Malaria control ProgrammesNational malaria Control Program. (NMCP) in 1953National Malaria eradication Program. (NMEP) in 1958Modified Plan of Operation (MPO) in 1977Enhanced Malaria Control Project. In 1997

• Selection of PHC for EMCPa. API (Annual Parasite Incidence) of >2 for at least 3yrs.b. P.falciparum cases being >30% of total malaria cases.c. 25% population of PHC being tribal. d. Reported death due to malaria from the PHC.

Main components strengthened under this project1. Early case detection – by providing card test.2. Early treatment – by Malaria kit & artesunate , artemesin.3. Personal Protection – by providing ITN (Insecticide treated Net)4. vector Control – by se of larvivorous fish e.g Gambusia affinis, Lebister reticulatus.

In uncomplicated P.falciparum malaria (adult)

1st day Chloroquine 600mg base

+

Primaquine 45mg(0.75mg/kg)

2nd day Chloroquine 600mg base.

3rd day Chloroquine 300mg base.

Uncomplicated P.vivax

Chloroquine 25mg/kg over 3days as above.

Primaquine 0.25mg/kg daily for 14days (adult 15mg daily)

National Filaria Control Programme

under NVBDC Prog.

• Complete treatment of microfilaria positive cases with DEC.

• Participation and arrangement of Mass Drug Administration (MDA)

with DEC and albendazole on National Filaria Day every year along

with management of side effects if any.

• Morbidity management of Lymphoedema cases.

National Leprosy Eradication Programme (NLEP)

• WHO Classification for treatment purpose:

• Pauci-bacillary leprosy(PB):- 1-5 skin lesion &/or one nerve involvement.

• Multi-bacillary:- Having 6 or > Skin lesions &/or more than one nerve involvement.

MB adult MB childRifampicin: 600mg once a month supervised 450mgDapsone 100mg daily 50mgClofazimine 300mg once a month supervised 150mg

50mg daily 50mg alt. dayDuration of Tt: 12 month 12 month

P.B Adult P.B ChildRifampicin: 600mg once a month supervised 450mgDapsone: 100mg daily 50mgDuration: 6month 6 month

Multi Drug Therapy (MDT)

National Programme for Control Of Blindness

• Facilities available at CHC are:> Diagnosis and treatment of common eye diseases.

> Refraction services

> surgical services including cataract by IOL implantation at selected CHCs

optionally.

( 1 eye surgeon has been envisaged for every 5 lakh population.)