SISTER NIVEDITA GOVERNMENT NURSING

COLLEGE
I.G.M.C SHIMLA

SUBJECT: COMMUNITY HEALTH NURSING

TRAINING AND SUPERVISION OF HEALTH WORKER\
PERSONNEL

SUBMITTED TO: SUBMITTED BY:

Dr. Pushpa Panwar Roll No. 03
Lecturer Cum HOD Shivani
(Community health nursing ) M.sc. Nursing IIsnd Year
SNGNC IGMC Shimla SNGNC,IGMC,Shimla

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 TRAINI
NG AND SUPERVISION OF HEALTH WORKER\ PERSONNEL

TEAM:
Team is a group of two or more person who work together for common
purpose. A team is defined as group of person with different levels of
knowledge, abilities and personalities who must complement each other
and who share a common goal.

HEALTH TEAM:-
A health team is group of person who work together
to promote better health in the community. The health team members
functions according to the rules laid down by the ministry of health
and family welfare , Govt. of India in consonance with their policies.
A team of health personnel together can provide better health services
than when they are functioning alone.

CHARACTERISTICS OF A TEAM:-
o Team have an objective
o Team follows rules
o Team organizes themselves to achieve their objectives
o Team members cooperate

COMMUNITY HEALTH NURSING TEAM :- community health team refers to a

group of people working together for common goal in order to provide preventive ,
promotive , curative, rehabilitative services. Community health nursing team involves the
following members:
▪ Physician
▪ Female health worker
▪ Male health worker
▪ Female health assistant
▪ Male health assistant
▪ Dai
▪ Anganwadi worker
▪ Depot Holder
▪ Village health guide
▪ Voluntary health associations
▪ PHN/DPHNO

FUNCTION OF COMMUNITY HEALTH CARE TEAM

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 ⮚ Maternal and child health services
⮚ Family planning
⮚ MTP
⮚ Control and prevention of communicable disease
⮚ Dai training
⮚ Registration of vital events
⮚ Maintenance of records
⮚ Provision of primary medical care
⮚ Team activities
⮚ To conduct survey
⮚ Organize and implementation of immunization programme
⮚ Identification of reports about communicable disease
⮚ To provide follow up and referrals
⮚ Guiding the health worker for planning programmes.
⮚ Conducting group meeting
⮚ Organization of health programmes
⮚ Supervision and guidance
⮚ Supplies, equipment maintenance
⮚ Training
⮚ Primary medical care
⮚ Continuing education
⮚ Cooperative activities within the team members and village person
⮚ Plan for visiting
⮚ Administration in primary and sub centers and district levels. Supervision of health
care team.
⮚ Education, orientation, in service education, dais training, training of students.
⮚ Provision of school health services
⮚ Carryout laboratory investigations ( malaria , TB) and medication administration on
prescription

TRAINING OF HEALTH PERSONNEL

In the health care setting, just an education improves the knowledge of a person, training
entrance the aptitude, skill and abilities of employees to perform specific job better.

DEFINITION:- Training is the act of increasing knowledge and skill of an employee for
doing a particular job

BENEFITS:
● Quick learning
● Higher productivity
● Standardization of procedure
● Less supervision

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 ● Economical operations
● Higher morale
● Preparation of future managers
● Better management

METHODS OF TRAINING
o On the job training
o VESTIBULE TRAINING
o SPECIAL COURSES OR CLASSROOM TRAINING.

SUPERVISION OF HEALTH WORKER

Supervision means overseeing the employees at work.
It has been defined as the authoritative direction of work
of one’s subordinates. It means observing the subordinate
at work to see that they are working according to plan and
policies of the organization and keeping the time schedule
and to help them in solving their work problems. Supervision
is a process of helping and enabling a co- operative relationship
between the supervisor and the supervised

OBJECTIVES OF SUPERVISION:
1. To help the staff to do their job skillfully and effectively to give maximum output
with minimum resources – cost effectiveness
2. Help the staff develop the individual capacity to the fullest extent with a view to
channel the same in favor of work
3. Guide or assist in meeting predetermined work objectives or targets. In nursing
preventive , promotive , curative and rehabilitative care to people
4. Help to promote effectiveness of the subordinate \ staff ensuring that the subordinate
staff or supervisor dose what he\ she supposed to do
5. Help to motivate subordinate to maintain high morale
6. Help the members of the team to recognize problem, identify solution and to take
action.
7. Help to develop team spirit and promote team work for effective functioning
8. Help to promote the attitude of the members towards the work program

SUPERVISION METHODS OF STAFF AND INDIVIDUAL:

Supervision strives to make the ward a platform for good learning. It should be well planned.
Good supervision helps the nurse to think and act for her, set up her own objectives and also

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to attain them through approval, recommendation and self-analysis. It helps to enhance the
personality of the nurse.
1. TECHNICAL VS CREATIVE SUPERVISION :- Technical methods are some of
the basic supervisory skills which need to be trained through group conferences and
group discussion. For examples techniques of services study, record construction,
time study etc. creative supervision provides maximum adaptation to the situation.
For example instead of orientation period of two weeks for each new staff members,
a variable plan in both content and time according to the needs of each individual
should be formulated.
2. CO-OPERATIVE VS AUTHORITARIAN SUPERVISION :-In cooperative
supervision there is a full participation of each members of the group in planning,
action and decision whereas in authoritarian supervision responsibility ventures
entirely on the supervision with the staff following his\her discretion.
3. SCIENTIFIC VS INTUITIVE SUPERVISION:
Scientific supervision relies on objective study and measurement than personal
judgment or opinion. Whereas intuitive supervision needs to maintain the
interpersonal relationship. The supervision needs a sensitive and intuitive reaction to
the emotional needs of the other person.

SUPERVISION OF NURSING PROCEDURES:

1) CONFERENCES: The individual and group conferences are methods of
supervision. In they are among the most valuable of supervisory techniques.

2) INCIDENTAL TEACHING AS A METHOD OF SUPERVISION: An interested,

alert, imaginative community health nursing recognize the magnitude of the
opportunity that every incident which occurs in the ward provides a rich possibilities
for incidental teaching.
3) MAINTENANCE OF INTEREST; it is necessary for some person to feel that their
work has value for others. Interest in the job is proportionate to the opportunity for
the worker to satisfy his basic human needs. The community health nurse will find
that judicious praise and commendation for work go far in sustaining interest and
improving the quality of work.
4) MAINTENANCE OF MORALE: Morale is maintenance when an interest is
shown in the worker. He likes to feel that he is a part of the institute. Efficiency can
be achieved only with good personal relations. Periodic conferences of both groups
and individual help to maintain morale.

COMMUNITY HEALTH WORKER

Indian government introduced a CHW scheme across the country 1977 envisaging
“provision of health services at the doorsteps of the villagers “. However the name of the

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 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

A village guide is a person with an aptitude for social
service and is not a full time Govt functionary. The
village health guides scheme was introduced on 2nd
oct 1977 of securing people participation the care
of their own health.The health guides are now mostly
women. A circular was issued by Govt of India in may
1986 that male health guides would be replaced by female
health guides.
The scheme included training of one community health
volunteer for everyvillage community comprising of
1000 population. There are 3.23 lakh village health guide functioning in the country.

OBJECTIVES OF VILLAGE HEALTH GUIDE

1. To provide basic curative, preventive and promotive health care at the door-steps of
the people
2. To involve rural people in the provision monitoring and control of basic health
services to place" people's health in people hand"
3. To create a resource person trusted by the local population who could provide link
between primary health centers and the local community.

STANDARDS CONCERNING THE VILLAGE HEALTH GUIDE

PROFILE:
1. He was to live in the village and permanent resident of local community preferably
women.
2. Have minimal schooling at least up to 5 th standard and be willing to devote two to
three hours a day to community health activities.
3. He had to be acceptable to all the groups forming the community, and was not to be a
member of any political organization.

ROLES OF VILLAGE HEALTH GUIDES

1. The VHG was expected to know the health need of the community and provide basic
health services minor treatments, preventive measures, including education and
liaison with specialized health institutes
2. He/She would receive a manual of instructions and a health kit for his/her works as
well as a small supply of medicine for first treatment, if the action requires was
beyond his/her skill or resources
3. He/she would draw on the resources of the formal health structure and in the process
render it more responsive to community needs.

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4. The VHG was expected to educate the village population about health problems,such
as family planning or public sanitation and personal hygiene,which might not be
perceived by the community members as their felt needs.
5. A VHG used to be change agent as well as a representative of the community.

TRAINING
After the VHG was identified and approved by the selection community, he\she used to
undergo throughout months training in simple and basic health care center at the PHC.
During the training period of 200 hours, the community health volunteer used to receive
from the government, a monthly stipend of Rs 200 after the training, the VHG used to
spent 2-3 hours a day for health work in his community.
The raining program is being continued during the 9 th five year plan period (1997-2000)
to achieve the national target of one VHG for each village or 1000 rural population. On
completion of training, they receive a working manual and a kit of simple medicines
belonging to the modern and traditional system of medicine in vague in the part of the
country to which they belong. The manual or guidebook gives them detailed information
about medical care of common illness- of what they can or cannot do.
They are expected to do community health work in their spare time of about 2
to 3 hours daily for which they are paid an honorarium of Rs. 50 per month and drug
worth Rs 600 annum.

LOCAL DAIS
Under the rural health scheme to train all categories
of local dais ( traditional birth attendants) in the
country to improve their knowledge in the elementary
concepts of maternal and child health and sterilization
beside obstetric skills.

Consideration in dais training:

⮚ Some dais will grasp subject fastly while others will be slow. The teaching must
be in simple language and should be repeated.
⮚ Dais learn best in small groups
⮚ They learn best when they participate in the learning process
⮚ Dais vocabulary is small and simple. she learn new terms slowly
⮚ Discuss, ask questions and learn how they do things before each class and
demonstration
⮚ Evaluate your teaching observe supervise 5 or more deliveries in each year

TRAINING OF DAIS
● The training is for 30 working day
● Each day is paid stipend of Rs 300 during her training

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 ● Training is given at the PHC, sub center, or MCH center for 2 days in a week and on
the remaining days of the week they accompany the health worker (F).
● During her training period each dais is required to conduct at least 2 deliveries under
the guidance and supervision of health worker ANM or health assistance (F)
● The emphasis during training is on asepsis so that home deliveries are conducted
under safe hygienic condition there by reducing the maternal and infant mortality
● After successful completion of training each dais is providing with a deliveries kit and
certificate
● She is entitled to receive an amount of Rs 10\ deliveries provided the case is
registered with the sub center \PHC
● During training session each dais should be allowed to conduct 5 deliveries under
supervision
● To each infant registered by her. She will receive Rs 3.
● The dais are also expected to play vital role in programming small family norms since
they are acceptable to the community
● Although the national target is to train 1 local dais each village ,the 8 th five ear plan’s
objectives was to train all untrained dais practicing in the rural areas

ANGANWADI WORKER TRAINING

Under the ICDS scheme there is an Anganwadi worker
for a population 1000. There are about 100 such worker
in each ICDS project. As of date over 5320 ICDS blocks
are functioning in the country
The Anganwadi workers are selected from community.
She undergoes training in various aspects of health
nutrition, child development for 4 months.
She is a part time worker is paid an honorarium of
Rs 200-250 \month for the services rendered , which
include health checkup , immunization , supplementary
nutrition , health education , non- formal pre-school
education and referral services.

ANM/ MULTIPURPOSE HEALTH WPRKERS (FEMALE)

⮚ She plays a vital role in maternal & child health as well as in family welfare services
in rural areas. Therefore it is essential that the proper training to be given to them so
that quality services to provided to the rural population. For this purpose 336
ANM/MULTIPURPOSE HEALTH WORKRES(F) schools with an admission
capacity of approx.13,000 & 42 promotional training schools for LHV/HEALTH
ASSISTANT (F) with an admission capacity of 2600 established by the department
of family welfare, Govt. of India.

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 ⮚ These training institutions are imparting training to prepare required number of
ANM $ LHV to man the sub-center, PHC, rural family welfare center and other
health center in the community.
⮚ The duration of training program of ANM is 1& 1/2 years & min. qualification to
this course is 10th passed. Senior ANM with 5yrs of experience is given 6mnth
promotional training to become LHV/HEALTHASSISTANT (f).
⮚ LHV/HEALTHASSISTANT provides supportive supervision & technical guidance
to the ANMs in sub-center.

MULTIPURPOSE HEALTH WORKER (MALE)

The basic training of multipurpose health worker (m)
scheme was approved during 6th 5 year plan & taken
up since 1984 as a 100% centrally sponsored scheme.
The training is provided through 56 training center through health and family welfare
training center and through basic training schools of multipurpose health worker (m). The
training is of 1yr duration, on successful completion of training, the male health workers are
posted at the sub center along with ANM/HEALTHWORKER (F). The main function of the
male multipurpose health workers are in the areas of national health program like malaria,
leprosy, TB & limited involvement in diarrhea control program and in family welfare
services.

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.
Key components of ASHA:
⮚ ASHA must be a woman resident of the village married/ widowed/ divorced,
preferably in the age group of 25 to 45 years. She should be a literate woman with
due preference in selection to those who are qualified up to 10 standard wherever they
are interested and available in good numbers.
⮚ ASHA will be chosen through a rigorous process of selection involving various
community groups, self- help groups, Anganwadi Institutions, the Block Nodal
officer, District Nodal officer, the village Health Committee and the Gram Sabha.
⮚ Capacity building of ASHA is being seen as a continuous process. ASHA will have to
undergo series of training episodes to acquire the necessary knowledge, skills and
confidence for performing her spelled out roles.

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 ⮚ The ASHAs will receive performance-based incentives for promoting universal
immunization, referral and escort services for Reproductive & Child Health (RCH)
and other healthcare programs, and construction of household toilets.
⮚ Empowered with knowledge and a drug-kit to deliver first- contact healthcare, every
ASHA is expected to be a fountainhead of community participation in public health
programs in her village.
⮚ ASHA will be the first port of call for any health related demands of deprived sections
of the population, especially women and children, who find it difficult to access
health services.
⮚ ASHA will be a health activist in the community who will create awareness on health
and its social determinants and mobilize the community towards local health planning
and increased utilization and accountability of the existing health services.
⮚ She would be a promoter of good health practices and will also provide a minimum
package of curative care as appropriate and feasible for that level and make timely
referrals.
⮚ ASHA will provide information to the community on determinants of health such as
nutrition, basic sanitation & hygienic practices, healthy living and working
conditions, information on existing health services and the need for timely utilization
of health & family welfare services.
⮚ 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
Infections (RTIs/STIs) and care of the young child.
⮚ She will act as a depot older for essential provisions being made available to all
habitations like Oral Rehydration Therapy (ORS), Iron Folic Acid Tablet(IFA),
chloroquine, Disposable Delivery Kits (DDK), Oral Pills & Condoms, etc.
⮚ ASHA will mobilize the community and facilitate them in accessing health and health
related services available at the Anganwadi/sub-center /primary health centers, such
as immunization, Ante Natal Check-up (ANC), Post Natal Check-up supplementary
nutrition, sanitation and other services being provided by the government.
⮚ At the village level it is recognized that ASHA cannot function without adequate
institutional support. Women's committees, village Health & Sanitation Committee of
the Gram Panchayat, peripheral health workers especially ANMs and Anganwadi
workers, and the trainers of ASHA and in-service periodic training would be a major
source of support to ASHA.

TRAINING DIVISION DEPARTMENT OF FAMILY WELFARE

⮚ “BasicTraining of ANM/LHV”
⮚ “BasicTraining for Multipurpose HealthWorker (Male)”
⮚ Maintenance of Health and FamilyWelfare Training Centre
⮚ Gandhigram Institute of Rural Health and Family WelfareTrust (GIRHFWT)
⮚ National Institute of Health and FamilyWelfare (NIHFW)

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 ⮚ Rural HealthTraining Centre, Najafgarh
⮚ FamilyWelfareTraining & Research Centre, Mumbai.

1. BASIC TRAINING OF ANM/LHV

ANMs/LHVs play a vital role in MCH and Family Welfare Service in the rural areas. It is
therefore, essential that the proper training to be given to them so that quality services be
provided to the rural population.
This purpose 319 ANM / MPHW (Female) schools with an admission capacity of
approximately 13,000 and 34 promotional training schools for LHV/ Health Assistant
(Female) with an admission capacity of 2600 are imparting pre-service training to prepare
required number of manpower to man the Sub centers, PHC, CHC, Rural Family Welfare
Centers and Health posts in the country.
2. BASIC TRAINING FOR MULTIPURPOSE HEALTH WORKER (MALE)
The Basic Training of MPHW (M) scheme was approved during 6 th Five-Year Plan and
taken up by GOI in 1984.There are 49 basic training schools of MPHW (Male).
• Duration of course is 1 year and on successful completion of the training, the candidate is
posted as MPHW (M) at the sub- center. Maintenance of Health and Family Welfare Training
Centre
• 49 HFWTCs were established in the country in order to improve the quality and efficiency
of the Family Planning Programs.
• These training centers are supported under Scheme of “Maintenance of HFWTCs”. Key
role of these training centers is to conduct various in-service training programs of Department
of Family Welfare.
• Apart from in-service education some of the selected centers have an additional
responsibility of conducting the basic training of MPHW’s course where MPW training
centers are not available.
3. MAINTENANCE OF HEALTH AND FAMILY WELFARE TRAINING CENTER
49 HFWTC were established in the country in order to improve the quality and efficiency of
the family planning programs. These training centers are supported under scheme of
maintenance of HFWTCs “key role of these training centers is to conduct various in – service
training programs of department of family welfare. Apart from in – service education some of
the selected centers
Apart from in-service education some of the selected centers have an additional
responsibility of conducting the basic training of MPHW’s course where MPHW training
centers are not available.
4.GANDHI GRAM INSTITUTE OF RURAL HEALTH AND FAMILY WELFARE
TRUST (GIRHFWT)

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• Established in 1964 with financial support from Ford Foundation, Government of India and
Government of Tamilnadu. The Health and Family Welfare Training Centre at GIRHFWT is
one of 49 HFWTCs in the country.
• It trains Health and allied manpower working in PHC, Corporations / Municipalities and
Integrated Nutrition Projects.
• Gandhigram Institute is also engaged in upgrading the capabilities of ANMs, staff nurses
and students of nursing colleges through the Regional Health Teachers Training Institute
(RHTTI).
• The RHTTI has under taken following activities.
a) Diploma in Nursing Education and Administration (DNEA)
b) Short- term training in community health nursing

5.FAMILYWELFARETRAINING & RESEARCH CENTRE, MUMBAI,

FAMILYWELFARETRAINING & RESEARCH CENTER (F.W.T. & R.C.),
Mumbai is a Central Training Institute responsible for the in-service training for different
categories of peripheral and grass root level health personnel all over the country, in the key
health areas of public health significance viz. Primary Health Care for Family Welfare,
R.C.H., HIV/AIDS and other integrated National Health Programs.
The Centre conducts a formal one year residential academic program for Diploma in Health
Promotion Education for the candidates deputed from all-over-the country and also for
candidates sponsored by WHO/UNICEF/UNDP/DANIDA etc. The first course of D.H.P.E.
was started in the year 1987-88. At present the 25thbatch of the course is in progress, with 18
trainees.
FWTRC Mumbai started another residential academic program for Post-graduate Diploma in
Community Health Care, in 2007.The duration of the course is 15 months.
6. NATIONAL INSTITUTE OF HEALTH AND FAMILYWELFARE (NIHFW)
National Institute of Health & Family Welfare (NIHFW) has been identified as the Nodal
Institute for training under NRHM and RCH–II, till 30 th September 2012. NIHFW has
pursued responsibilities of organizing National Level Training Courses and coordination of
the NRHM / RCH training activities with the help of 18 Collaborating Training Institutions
(CTIs) in various parts of the country. Four more institutions i.e. RHFWTC at Srinagar, J &
K, RIHFW at Haldwani, Uttarakhand, Regional Institute of Paramedical and Nursing
Sciences (RIPANS) at Aizawl and Institute of Public Health (IPH) at Ranchi, Jharkhand have
been approved to function as CTIs. The activities undertaken by NIHFW are as follows:
i. Central Training Plan
ii. Human Resource: A total number of 43 Consultants and 44 Technical Assistants
are in position at 18 CTIs.
iii. Monitoring of progress and quality of trainings
iv. Professional Development Course in Management, Public Health & Health Sector
Reforms for DMOs

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 v. Research Studies

7 . RURAL HEALTHTRAINING CENTRE, NAJAFGARH, NEW DELHI

Rural health training center, Najafgarh was established as a Najafgarh health unit with the
assistance of ROCKFELLER foundation in 1937 and merged in rural health training center
(RHTC) in 1969.There are 3 PHC under RHTC, Najafgarh:-
1. Palam
2. Najafgarh
3. Ujwa
Basically RHTC, Najafgarh is a training center for the community health/rural health
training. This center is imparting training to nearly 2,500 trainees every year which includes.
Medical interns 3-6 months internship of rural health course under rural orientation of
medical education (ROME). Nursing students of 1st & 3rd year of GNM course from
different nursing training schools of Delhi are being trained. approx. 1200 such students are
trained every yr. ANM 10+2 (voc.) training school under CBSE affiliated with INC is also
being run $ every year 20 students are being admitted for 2yrs certificate course. Training
related to rural health is also provided in the form of different courses like PGDHE, TBA,
LHV, PHN, food & nutrition, health economics & anganwadi worker etc. Health education is
an integral part of training component & service component for demand generation
&behavioral change.
BILIOGRAPHY

⮚ Dash Bijayalaskhmi “A comprehensive textbook of community health nursing” 1st

edition, published by Jaypee Brother’s, Ansari Road New Delhi, page no. 400-410.
⮚ Gulani k.k. “Community health nursing” 2nd edition, Published by Kumar publishing
house, Pitampura, Delhi, page no. 590-592.
⮚ Arasi Michael Jeba, “Textbook of community health nursing-II ” 1 st edition,published
by Saurabh Medical Publishers, Chandigrah, page no 78-80.
⮚ Firoz Qureshi, trinaing and supervision of health workers, Date of publication 14-07-
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Available from: https://www.slideshare.net/FIROZQURESHI/training-amp-

supervision-of-health-workers

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