SUBMITTED TO: SUBMITTED BY:

MR. BAKIM KIRAN

NURSING TUTOR Msc. (N) 1ST YEAR

COMMUNITY HEALTH NURSING ROLL NO-1915715

SUBMITTED ON: 3 OCT 2015

 LESSON PLAN

Name of the student teacher : Kiran

Class : M.Sc. Nursing 1st year

Name of the subject : Community Health Nursing

Name of the Teaching : Community health centre

Group : BSc nursing 2nd year

Size of Group : 98

Name of Supervisor : Mr. Bankim

Date of Submission : 3 oct 2015

Date and time of presentation : 2 nov. 2015, 2 pm

Duration : 60 minutes

A.V Aids : Charts, powerpoint slides

Previous knowledge: The group has already some basic knowledge about community health centre.

General objective: At the end, students will be able to acquire knowledge and understanding regarding community health centre.
Specific objective:

At the end, students will be able to :-

 define the community health centre

 explain services provided in community health centre
 discuss physical infrastructure of community health centre.
 list down staffing pattern of community health centre.
TIME SPECIFIC CONTENT TEACHING AND EVALUATION
OBJECTIVE LEARNING
ACTIVITIES
2 min Student will Myself Kiran,
be able to: student of M.Sc[N]
develop 1st year, from M.M
rapport with College of Nursing
the Group. Mullana [Ambala]

announce the Today, I am going

topic. to discuss the topic
community health
Group will be centre.
able to:
introduce the INTRODUCTION
topic. Delivery of health care services is the burning issue of the present time.
The concern is to develop a system which ensures need based
comprehensive health care services to people at large specially those
living in remote and backward areas, using available resources
define the
2 min community DEFINITION
Community health centre is one of a network of clinics staffed by a group Student teacher Define
health centre.
will be able to community health
define CHC. centre?
TIME SPECIFIC CONTENT TEACHING AND EVALUATION
OBJECTIVE LEARNING
ACTIVITIES

of medical officer, ANM, GNM, Lab technician and other health care
professionals providing healthcare services to people in a certain area.
There are 4 CHC in Ambala - Mullana, Chaurmastpur, Shahzadpur, Brara.

There are 88 Proper CHC in Haryana, 7 CHC cum 50 Bedded Hospital, 15

Block PHC and 1 Fuctional CHC (Total- 110).

There are 5865 CHC in India.

5 min to describe DESCRIPTION OF COMMUNITY HEALTH CENTRE Student teacher

community  The idea of community health centres (CHCs) was evolved under will be able to
health centre the National Health Policy. The CHCs are established and funded describe
by the State Government under Minimium Need Programme started community health
in the first year of the fifth five year plan (1974-1978). centre.
 The CHCs were designed to provide referral health care for cases
from the primary level, subcentres and for cases in need of
specialist care approaching the centre directly. CHC comes in
secondary level of health care.
 4 PHCs are included under each CHC.
 It covers approximately 80,000 population in tribal/hilly areas and
1,20,000 population in plain areas.
TIME SPECIFIC CONTENT TEACHING AND EVALUATION
OBJECTIVE LEARNING
ACTIVITIES
 CHC is a 30 bedded hospital providing specialist care in medicine,
obstetrics and Gynaecology, surgery and paediatrics.
 It has one Operation Theatre, X-rays, labour room, and laboratory
facilities.

5 min to discuss ACCOUNTABILITY

accountability It is mandatory for every CHC to have functional “Rogi kalyan Samiti” Which makes
of CHC. (RkS) to ensure accountability and also shall have the Charter of Patients’ CHC
Rights displayed prominently at the entrance accountable?

QUALITY OF SERVICES
Standard Operating Procedures and Standard Treatment Protocols for
common ailments and the National Health Programmes should be available
and followed. To maintain quality of services, external monitoring through
Panchayati Raj Institutions and internal monitoring at appropriate intervals
is advocated. Guidelines are being provided for management of routine and
emergency cases under the National Health Programmes so as to maintain
uniformity in Management in tune with the National Health Policy.

SERVICE DELIVERY IN CHC

Student teacher Enlist services
15 min  OPD services and IPD services: general medicine, surgery,
to enlist enlist services provided in CHC.
obstetrics and gynaecology, paediatrics, dental and AYUSH
services provided in CHC.
services.
provided in
 Eye specialist services ( at one for every 5 CHCs)
CHC.
TIME SPECIFIC CONTENT TEACHING AND EVALUATION
OBJECTIVE LEARNING
ACTIVITIES
 Emergency services- Handling of emergencies like Intestinal
Obstruction,
Haemorrhage, Dengue Haemorrhagic Fever, Cerebral Malaria
and others like Dog and snake bite cases, Poisonings,
Congestive Heart Failure, Left Ventricular Failure, Pneumonia,
acute respiratory conditions, Burns, Shock, acute dehydration etc.
 Laboratory services –
CLINICAL PATHOLOGY-
 Haematology –
Haemoglobin estimation
Total Leucocyte count
Differential Leucocyte count
Absolute Eosinophil count
Reticulocyte count
Total RBC count
E.S.R.
Peripheral Blood Smear
Malaria/Filaria Parasite
Platelet count
Packed Cell volume
Blood grouping
Rh typing
Blood Cross matching
TIME SPECIFIC CONTENT TEACHING AND EVALUATION
OBJECTIVE LEARNING
ACTIVITIES
 Urine Analysis - Urine for Albumin, Sugar, Deposits, bile salts,
bile pigments,
acetone, specific gravity, Reaction (pH)
 Stool Analysis - Stool for Ovacyst
PATHOLOGY-
Sputum - Sputum cytology
MICROBIOLOGY- Smear for AFB, KLB Grams Stain for Throat
swab
SEROLOGY- VDRL, Pregnancy test, WIDAL test
BIOCHEMISTRY - Blood Sugar Blood urea, Liver function tests,
Kidney function test
CARDIAC INVESTIGATIONS- ECG
OPHTHALMOLOGY- Refraction by using Snellen' chart
RADIOLOGY- X ray for Chest, Skull, Spine, Abdomen, bones
Dental X ray

 National Health programme

 Communicable disease programmes- Describe
1) RNTCP: CHC should provide diagnostic services through communicable
the microscopy centres which are already established in the diseases
CHCs and treatment services as per the Technical and programme.
Operational Guidelines for Tuberculosis Control
TIME SPECIFIC CONTENT TEACHING AND EVALUATION
OBJECTIVE LEARNING
ACTIVITIES
2) HIV/AIDS Control Programme: The services to be provided
at the CHC level are Integrated Counselling and Testing Centre.
Sexually Transmitted Infection clinic.
 National Vector Borne Disease Control Programme: The CHCs
are to provide diagnostic/linkages to diagnosis and treatment
facilities for routine and complicated cases of Malaria, Filaria,
Dengue, Japanese Encephalitis and Kala-azar in the respective
endemic
 Maternal health-
 Minimum 4 ANC check ups including Registration & Maternal health
associated services : As some antenatal cases may directly services include?
register with CHC
 Managing labour using Partograph.
 All referred cases of Complications in pregnancy, labour and
post-natal period must be adequately treated.
 Ensure post-natal care for 0 & 3rd day at the health facility
both for the mother and newborn and sending direction to the
ANM of the concerned area for ensuring 7th & 42nd day post-
natal home visits.
 Minimum 48 hours of stay after delivery, 3-7 days stay post
delivery for managing Complications.
TIME SPECIFIC CONTENT TEACHING AND EVALUATION
OBJECTIVE LEARNING
ACTIVITIES
 Proficiency in identification and Management of all
complications including PPH, Eclampsia, Sepsis etc. during
PNC.
 Essential and Emergency Obstetric Care including surgical
interventions like Caesarean Sections and other medical
interventions
 Family planning-
 Full range of family planning services including IEC,
counseling, provision of Contraceptives, Non Scalpel
Vasectomy (NSV), Laparoscopic Sterilization Services and
their follow up.
 Safe Abortion Services as per MTP act and Abortion care
guidelines of MOHFW.
 Newborn care and child health- . What are newborn
 Provisions of Janani Suraksha Yojana (JSY) and Janani Shishu and child health
Suraksha Karyakram (JSSK) as per guidelines. services?
 Essential newborn care and Resuscitation by providing
Newborn Corner in the Labour Room and Operation Theatre.
 Early initiation of breast feeding with in one hour of birth and
promotion of exclusive breast-feeding for 6 month.
 Counseling on Infant and young child feeding as per IYCF
(2004) guidelines.
TIME SPECIFIC CONTENT TEACHING AND EVALUATION
OBJECTIVE LEARNING
ACTIVITIES
 Routine and emergency care of sick children including Facility
based IMNCI strategy.
 Vitamin-A prophylaxis as per guidelines of Govt. of India.
 Tracking of vaccination drop outs and left outs.
 Prevention and management of routine childhood diseases,
infections and anaemia etc.
 Management of Malnutrition cases.
 Other services-
Micronutrient (Vitamin A & IFA) management: Weekly supervised
distribution of Iron- Folate tablets.
 coupled with education about the issue.
Administration of Vitamin-A in needy cases.
 De-worming -Biannually supervised schedule
 Monitoring & Evaluation
 Mid Day Meal

5 min to discuss STAFFING PATTERN FOR ASSISTANCE: Student teacher How many staff
staffing Personnel Essential Desirable discuss staffing are there in CHC.
pattern of Block medical officer/ 1 pattern of CHC.
CHC. medical superintendent
Public health specialist 1
Public health nurse 1 +1
TIME SPECIFIC CONTENT TEACHING AND EVALUATION
OBJECTIVE LEARNING
ACTIVITIES

General surgeon 1
physician 1
Obstetrician & 1
gynaecologist
Paediatrician 1
anaesthetist 1
Dental surgeon 1
General duty medical 2
officer
Medical officer- 1
AYUSH
Staff nurse 10
pharmacist 1 +1
Pharmacist- AYUSH 1
Lab technician 2
radiographer 1
dietician +1
TIME SPECIFIC CONTENT TEACHING AND EVALUATION
OBJECTIVE LEARNING
ACTIVITIES
Ophthalmic assistant 1
Dental assistant 1
Cold chain and vaccine 1
logistic assistant
O.T technician 1
Rehabilitation worker 1 +1
counsellor 1
Registration clerk 2
Data entry operator 2
Account assistant 1
Administrative assistant 1
dresser 1
Ward boys 5
driver 1 3
Total 46
TIME SPECIFIC CONTENT TEACHING AND EVALUATION
OBJECTIVE LEARNING
ACTIVITIES
5 min To describe PHYSICAL INFRASTRUCTURE: Student teacher Describe physical
physical describe physical infrastructure of
infrastructure The CHC should have 30 indoor beds with one Operation theatre, labour infrastructure of CHC.
of CHC. room, x-ray, ECG, laboratory facility, treatment room and wards separate CHC.
for male and female. In order to provide these facilities, following are the
guidelines-
 To the extent possible, the centre should be located at the centre of
the block headquarter in order to improve access to the patients.
 The area chosen should have the facility for electricity, all weather
road communication, adequate water supply, telephone etc.
 It should be well planned with the entire necessary infrastructure. It
should be well lighted and ventilated with as much use of natural
light and ventilation as possible.
 CHC should be away from garbage collection, cattle shed, water
logging area, etc.
 Disaster Prevention Measures: Building structure and the internal
structure should be made disaster proof especially earthquake
proof, flood proof and equipped with fire protection measures.
 CHC should not be located in low lying area to prevent flooding.
 CHC should have dedicated, intact boundary wall with a gate.
Name of the CHC in local language should be prominently
displayed at the entrance which is readable in night too.
TIME SPECIFIC CONTENT TEACHING AND EVALUATION
OBJECTIVE LEARNING
ACTIVITIES
 Fire fighting equipment: Fire extinguishers, sand buckets, etc.
should be available and maintained to be readily available when
needed. Staff should be trained in using fire fighting equipment.
Each CHC should develop a fire fighting and fire exit plan with the
help of Fire Department. Regular mock drills should be conducted.
 Pharmacy for drug dispensing and storage.
 Clean Public utilities separate for males and females.
 Suggestion/complaint boxes for the patients/ visitors and also
information regarding the person responsible for redressal of
complaints.
 Equipments for surgery, examination, delivery- normal and
caessarian etc should be there.
 Drugs used in emergency, antibiotic, blood transfusion etc should
be present.

5 min To discuss CURRENT NEWS OF COMMUNITY HEALTH CENTRES Student teacher

current news India's public-health system needs urgent attention, investment -especially
discuss current
of CHC. in the rural areas. There is an 83 percent shortage of specialist medical
professionals in community health centres (CHCs) across India, according news on CHC.
to the Rural Health Statistics-2015, released by the Ministry of Health and
Family Welfare. Arunachal Pradesh, Kerala, Manipur, Meghalaya and
Tamil Nadu are some of the states that have no surgeons in their CHC.
TIME SPECIFIC CONTENT TEACHING AND EVALUATION
OBJECTIVE LEARNING
ACTIVITIES
Then there is a 76-percent shortage of obstetricians and gynaecologists in
CHCs nationwide. India bears the world's greatest burden of maternal,
newborn and child deaths, according to the World Health Organization
(WHO).
Such statistics mean that specialised healthcare treatment in rural India is
difficult, which has driven rising numbers of people to costlier private
health care. In rural India, 58 percent of hospitalised treatment was carried
out in private hospitals, while in urban India the figure was 68 percent,
according to the Key Indicators of Social Consumption on Health 2014
survey, carried out by National Sample Survey Office (NSSO).
In non-hospitalised treatment, 72 percent of health needs in rural areas
were treated by the private sector -- including private doctors, nursing
homes and private hospitals hospitals and charitable institutions, the survey
said.
There is only one doctor per 1,700 citizens in India; the World Health
Organisation stipulates a minimum ratio of 1:1,000.
There are 387 medical colleges in the country—181 in government and
206 in private sector. India produces 30,000 doctors, 18,000 specialists,
30,000 AYUSH graduates, 54,000 nurses, 15,000 ANMs and 36,000
pharmacists annually.
Health ministry claims that there are about 6-6.5 lakh doctors available.
But India would need about four lakh more by 2020 to maintain the
required ratio of one doctor per 1,000 people.
TIME SPECIFIC CONTENT TEACHING AND EVALUATION
OBJECTIVE LEARNING
ACTIVITIES
2 min to conclude the CONCLUSION Student teacher
topic The nurses working in community health care settings need to know and will be able to
understand the health care system, organizational structure, planning and conclude the topic.
the delivery of health care services to the people. Because it is within this
system the community health nurses work and have opportunity to help
people to promote and protect their health.
BIBLIOGRAPHY

BOOKS:

 Kishore J. National health programs of India. 11thedition. Delhi:Century publications. P-81, 27,119.
 Gulani K.K. Community health nursing. 1st edition. Delhi:kumar publishing house. P-334,424,565.
 Basavanthapa B T. Community health nursing. 2nd edition. Delhi:Jaypee brothers. P- 922.

INTERNET:

 health.bih.nic.in/docs/guidelines-community-health-centres.pdf.