Health care system-:

(1) At village level

(2) At sub center level

(3) At PHC level

(4) At CHC level

(1) At village level:

At the village level, elementary services are rendered by

(a) Village health guides

(b) Local dais

(c) Anganwadi workers

(d) ASHA

a) Village health guides:-Village health guide is a person with an aptitude

for social service and is not full time govt. functionary. Village health
guides scheme was introduced on 2nd oct. 1977.
Guidelines for their selection-

(1) They should be permanent resident of the local community, preferably

women

(2) They should be able to read and write, having minimum formal education at
least up to the VI std.

(3) They should be acceptable to all sections of community

(4) They should be able spare at least 2 to 3 hours every day for community
health work.

After selection the health guide undergo a short training in primary health care.
The training is arranged in the nearest PHC, sub-center or other suitable place
for the duration of 200 hours, spread over a period of 3 months. During the
training period they receive a stipend of Rs.200 per month.

Functions of Village health guides:

(1) Provide treatment for common minor ailments

(2) First aid during accidents and emergency

(3) MCH care

(4) Family planning

(5) Health education

b) Local dais:- Most deliveries in rural areas are handled by untrained dais.
The training for dais given for 30working days. Each dai is paid stipend
of Rs. 300during the training period. The training is given at PHC,
subcenters or MCH center for 2 days in a week and on the remaining four
days of the week they accompany the health worker(female) to the
village. During her training each dai is required to conduct at least 2
deliveries under the supervision and guidance of health worker (female),
ANM, health assistant (female).
Functions of dais:

o MCH care
o Family planning
o Immunization
o Education about health
o Referral services
o Safe water and basic sanitation
o Nutrition
Anganwadi worker:- Under the ICDS scheme there is an Anganwadi worker
for a population of 1000.There are about100 such workers in each ICDS project.
The anganwadi worker is selected from the community and she undergoes
training in various aspect of health, nutrition and child development for 4
months. She is a part time worker and paid an honorarium of Rs.200-250per
month for the services.

Functions of anganwadi worker:-

(1) MCH care

(2) Family planning

(3) Immunization

(4) Education about health

(5) Referral services

(6) Safe water and basic sanitation

(7) Supplementary nutrition

(8) Non-formal education of children

Accredited Social Health Activist(ASHA):- 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 activist – ‘ASHA’ or Accredited Social Health
Activist. Selected from the village itself and accountable to it, the ASHA will be
trained to work as an interface between the community and the public health
system. Following are the key components of ASHA.

SELECTION OF ASHA:-

 The general norm will be ‘One ASHA per 1000population’. In tribal,

hilly, desert areas the norm could be relaxed to one ASHA per habitation,
dependant on workload etc.
 The States will also need to work out the district and block-wise
coverage/phasing for selection of ASHAs.
 It is envisaged that the selection and training process of ASHA will be
given due attention by the concerned State to ensure that at least 40
percent of the ASHA in the State are selected and given induction
training in the first year as per the norms given in the guidelines. Rest of
the ASHAs can subsequently be selected and trained during second and
third year.
Criteria for Selection:-

 ASHA must be primarily a woman resident of the village

‘Married/Widow/Divorced’ and preferably in the age group of 25 to 45
yrs.
 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 EighthClass.
Roles and responsibilities of ASHA:-

 Provide information to the community on determinants of health such as

nutrition, basic sanitation & hygienic practices, healthy living.
 She will counsel women on birth preparedness, importance of safe
delivery, breast-feeding and complementary feeding, immunization,
contraception and prevention of common infections including
Reproductive Tract Infection/Sexually Transmitted Infection (RTIs/STIs)
and care of the young child.
  ASHA will mobilize the community and facilitate them in accessing
health and health related services available at the village/sub-
center/primary health centers, such as Immunization, Ante Natal Check-
up (ANC), Post Natal Check-up (PNC), ICDS, sanitation and other
services being provided by the government.
 ASHA will provide primary medical care for minor ailments such as
diarrhea, fevers, and first aid for minor injuries.
 She will also act as a depot holder for essential provisions being made
available to every habitation like Oral Rehydration Therapy(ORS), Iron
Folic Acid Tablet(IFA), chloroquine, Disposable Delivery Kits(DDK),
Oral Pills & Condoms, etc. She will inform about the births and deaths in
her village and any unusual health problems/disease outbreaks in the
community to the Sub-Centers/Primary Health Centre.
 She will promote construction of household toilets under Total Sanitation
Campaign.

Sub Centre

There is a wide variety of health systems around the world, with as many
histories and organizational structures as there are nations. Implicitly, nations
must design and develop health systems in accordance with their needs and
resources. Sub Centre is community based rural institution for primary health
care.A midwifery kit for safe delivery and equipment kit for IUD insertion,
blood pressure, apparatus and weighing machine are available at sub centre
level.5000 population in plain areas and for every 3000 population in
hilly/tribal/desert areas.

Sub centre:-Sub centre is the most peripheral and first contact point between
the primary health care system and the community.

OBJECTIVES

a) Basic Primary health care to the community.

b) Achieve and maintain an acceptable standard of quality of care
c) Make the services more responsive and sensitive to the needs of the
community.

SERVICES TO BE PROVIDED IN A SUBCENTRE

1.Maternal and Child Health.

(i) Antenatal care

(ii) Intra-natal care

(iii) Postnatal care

2.Child Health

3. Family Planning and Contraception

4. Counselling and appropriate referral for safe abortion services

5. Adolescent health care

6. Assistance to school health services

7. Control of local endemic diseases such as

Malaria, Kala azar, Japanese Encephalitis,Filariasis, Dengue etc. and control of

Epidemics

8. Disease surveillance

9. Water Quality Monitoring

10. Promotion of sanitation including use of toilets and appropriate garbage

disposal.

11.Field visits

12.Community needs assessment

13.Curative Services

14.Training,Coordination and Monitoring

15.National Health Programmes

INDIAN PUBLIC HEALTH STANDARDS FOR SUBCENTRES

1. Maternal health care

2. Child health care

3. Family planning and contraception

4. Counselling and appropriate referral for safe abortion services.

5. Water quality monitoring

6. Promotion of sanitation

7. Community need assessment

8. Curative services for minor aliments

9. Training of ASHA

10. Coordinate the services

11. National health programme

SUBCENTER TEAM

 Health worker male – 1

 Health worker female – 1
 Voluntary worker –1
Total –3
The voluntary worker at the sub centre level should preferably be a trained birth
attendant and be paid Rs- 200/- at least with equal contribution by the
government of India and the concerned state.

PRIMARY HEALTH CENTER

The concept of primary health center is not new in India. The bore committee in
1946 gave the concept of a primary health center as a basic health unit to
provide as close to an curative and preventive care to the rural population with
emphasis on with preventive and promote aspect of health care.

One PHC for every 30,000 rural population in the plains and one PHC for every
20,000 population in hilly, tribal and back ward areas.

STRENGTHERING OF PHC UNDER NRHM

 PHC have been strengthened by regular supplies of essential drugs and

equipment’s.
 Up grading single doctor PHC to 2 doctors PHC by posting AYUSH
practionners at PHC level.
 Observing standards treatment protocols and Indian public health
standards.

FUNCTIONS OF PHC
  Medical care and referral services for subcenter.
 Essential obstetrical care and 24 hours delivery services.
 Initial emergency obstetrical care.
 MTP services.
 Services for RTI/STI.
 Essential new born care.
 Tubectomy/Vasectomy.
 Lab services
 School health services.
 Health and nutrition education.

PRIMARY HEALTH CENTRE TEAM

 Medical officer –1
 Health assistant male –1
 Health assistant female –1
 Health educator –1
 Health worker female –1
 Staff nurse –1
 Pharmacist –1
 Lab technician –1
 Upper division clerk –1
 Lower division clerk –1
 Driver –1
 Class IV –4
Total – 15

COMMUNITY HEALTH CENTRE

As on 31st march 2017, 5624 community health centres were established. Each
community health centre a population of 80,000 – 1,20,000 at community plain
areas.

The CHC are established and maintained by the state government. The senior
most medical officer is responsible to manage the CHC. Each CHC has four
primary health centres. CHC is required four medical specialist i.e. Surgeon,
Physician, Gynaecologist and paediatrics are available at the level of CHC.

INDIAN PUBLIC HEALTH STANDARDS FOR COMMUNITY

HEALTH CENTRES

 Care of routine and emergency cases in surgery.

 Care of routine and emergency cases in medicine.
 24 hour delivery services, including normal and assisted deliveries.
 Essentials and emergency obstetric care.
 Full range of family planning services including laparoscopic services.
 Safe abortion services.
 New born care.
 Routine and emergency care of sick children.
 Other :-
A. Blood storage facility
B. Essential laboratory services
C. Referral services

STRENGTHENING OF CHC UNDER NRHM

 Operating additional CHC to meet population norm.

 Two specialist namely anaesthetic and public health programme manager
will be provided.
 Provision of united money for location action.
 Initial fund of Rs 20 lakhs per CHC has been provided for its up
gradation.

FUNCTIONS OF CHC

 To provide specialist services and referral services.

 To provide emergency care and MTP services.
 Essential new born care.
  Services for national health programme.
 RTI/STI services.
 Lab and x-ray services.
 Integrated disease surveillance.
 Training and continuing education for health terms.
 Information, education and communication activities for specific
problem.
 To enhance public private partnership.
 To elicit community participation.

STAFFING PATTERN OF CHC

 Medical officers –4
 Ward boys –2
 Nurse midwives –7
 Sweepers –3
 Dresser –1
 OPD attendant –1
 Pharmacist –1
 Chowkidar –1
 Lab technician –1
 Data entry –1
 Radio graphers –1
 OT attendant –1
 Registration clerk –1

Total – 25

Job description of the members of the health team

(1) Medical officer:

 He is the captain of the health team at the primary health center.

 He devotes the morning hours attending to patients in the outdoor,in the
afternoon supervises the field work.
  He visits each sub center regularly on fixed days and provides guidance,
supervision and leadership to the health team.
 He spends one day in each month organizing staff meetings at PHC to
discuss the problems and review the progress of health activities.
 He ensures that national health programmes are being implemented in in
his area properly.
 The success of PHC depends largely on the team leadership which the
medical officer is able to provide.
 The medical officer must be a planner, the promoter, the director, the
supervisor, the coordinator as well as the evaluator.
2) Health worker female:

 She will register pregnant women from three months of pregnancies

onwards.
 Maintain maternity record, register of antenatal cases, eligible couple
register, children register up to date.
 She will provide care to pregnant women especially registered mother
throughout the period of pregnancy.
 Give advice on nutrition to expectant and nursing mothers about storage,
preparation and distribution of food.
 Immunize pregnant mothers with tetanus toxoid.
 Spread the message of family planning to the couples; motivate them for
family planning individually and in groups.
 Distribute contraceptives to the couples.
 Assess the growth and development of the infant and take necessary
action.
 Records and reports births and deaths in her area.
 Test urine for albumin and sugar and do Hb during her home visit.
 Arrange and help M.O and health assistant in conducting MCH and
family planning clinics at subcenters.
 Maintain the cleanliness of subcenter.
 Attend staff meetings at PHC, CD block or both.
3) Health worker male:-

 He will survey all the families in his area and collect all the information
about each village/ locality in his area.
 Identify the cases of communicable diseases and notify the health
assistant male and M.O PHC immediately.
 Educate the community about importance of control and preventive
measures against communicable diseases.
 Assist the village health guide in undertaking the activities under TB
programme properly.
  Educate community on the method of liquid and solid waste, home
sanitation, advantage and use of sanitary latrines.
 Assist the health assistant male in the school health programme.
 Utilize the information from the eligible couple and child register for the
family planning programme.
 Spread the message of family planning to the couples; motivate them for
family planning individually and in groups.
 Distribute contraceptives to the couples.
 Provide follow-up services to male family planning acceptors.
4) Health assistant female:-

 Supervise and guide the health workers in the delivery of health care
services to the community.
 Carry out supervisory home visiting.
 Guide the health workers (female) in Distribution of contraceptives to the
couples.
 Respond to urgent calls from the health workers and trained dais and
render necessary help.
 Organize and utilize the mahila mandal, teachers etc., in the family
welfare programme.
 Provide information on the availability of services for MTPs and refer
suitable cases to the approved institution.
 Supervise the immunization of all pregnant women and children (0-5
years)
 Collect and compile the weekly reports of births and deaths occurring in
his area.
 Educate the community regarding the need of registration of vital events.
5) Health assistant male:-

 Supervise the work of Health worker male during concurrent visit.

 Check minimum 10% of houses in village.
 Supervise the spraying of insecticides during local spraying along with
the health worker (male).
 Conduct immunization of all school going children with the help of
health worker (male).
 Supervise the immunization of all children’s (0-5 years).
 Assist M.O.PHC in organization of family planning camps.
 Provide information on the availability of services for MTPs and refer
suitable cases to the approved institution.
 Ensures follow-up of all cases of vasectomy, tubectomy, IUD and other
family planning acceptors.
  Ensure that all the cases of malnutrition infants and young childrens (0-
5years) are given the necessary treatment and advice and refer serious
cases to PHC.
 Ensure that Iron and folic acid and Vitamin A are distributed to the
beneficiaries.
 Organize and conduct training for dais women leaders with the help of
health workers
 Collect and compile the weekly reports of births and deaths occurring in
his area.
 Educate the community regarding the need of registration of vital events.

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