Annexure I

Name of the Position: Mid-level Health Care Providers for providing Comprehensive
Primary Health Care under Universal Health Coverage program.

CONTRACT

This CONTRACT (hereinafter called the “Contract”) is made on ……. day of …... 2020 by and
between District Health and Family Welfare Society (hereinafter called “the Client”) having its
principal office at District of Health & Family Welfare,_________ represented by its District Health
& Family Welfare Officer as First party which expression shall wherever the context so admits
includes successors, administrators and job assignees of the one part and Sri. …………..(hereinafter
called “Mid-level Health Care Provider for “Universal Health Coverage”) residing at
……………………………………….as Second party of the other part.

2. WHEREAS, the Client wishes to have the Mid-level Health Care Provider to perform the services
hereinafter referred to, and

3. WHEREAS, the Mid-level Health Care Provider is willing to perform these services,

4. NOW THEREFORE THE PARTIES hereby agree as follows:

1. This appointment is subject to the candidate successfully completing the IGNOU
training on “Certificate-Course in Community Health Nursing (CCHN)” to be
conducted by Indira Gandhi National Open University to gain/obtain the required
level of skills and knowledge, to carry out the roles and responsibilities of Mid-Level
Health Care Provider- assigned to the Employee as per the Terms of Reference and
guidelines of the NHM, DoHFW, Government of Karnataka and amended from time
to time, in the interest of the programme during the tenure of the employee.
2. In case the Employee fails to successfully complete the Bridge Course on Community
Health in the first attempt, he/she will be given a second successive attempt to clear
the exam, failing which he/she shall be discontinued from the service.
3. As the cost of training of the Employee is being borne by NHM, DoHFW, GOK, the
Employee hereby undertakes to stay in the employment with the First Party and work
at the designated Health and Wellness Centre for a period of not less than three years
as the Mid-Level Healthcare Provider.
4. In case the Employee fails to fulfill the above obligation he/she shall reimburse
NHM, DoHFW, GOK, a sum of Rs 2,50,000 (Rupees Two Lakh fifty Thousand Only)
towards functionality and operationalization expenses including training costs.
5. The Employee undertakes not to dispute the amount, and shall pay the amount at the
time of requesting the relieving order from the NHM, DoHFW, GOK.

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 6. If the Employee quits the service without an intimation and payment of indemnity
sum, the NHM, DoHFW, GOK will have the right to initiate appropriate legal
proceeding against the Employee.
7. Should the Employee desire to discontinue the service after a period of three years, a
one month prior notice shall be mandatory, and will not be liable to reimburse the cost
of Bridge Programme on Community Health to NHM, DoHFW, GOK. In this case if
there is discontinuation of service without prior notice to NHM, DoHFW, GOK
renders employee liable to lose the last one month of salary.
8. The Employee agrees to undergo all training programme and continued education
initiatives, or workshops conducted by NHM, DoHFW, GOK from time to time
during the period of employment.
9. The Employee undertakes to fulfill all Terms of Reference / Roles and
Responsibilities provided with the appointment order to the best of his/her
responsibility. Also shall comply to – abide to directions/instructions given by
Officers of the DoHFW.
Stipulations of the mutual agreement

(1) Services (i) The Mid-level Health Care Provider is appointed as UHC Programme
Mid-level Health Care Provider.

(ii) The Mid-level Health Care Provider shall perform the services as per the
Terms of Reference with Scope of Services as detailed in Annexure “A”

(2) Period of (i) The period of Contract is initiated after successful completion of
contract IGNOU –CCHN course for up to three years renewed for every year from
……… to ………..
(ii) This contract agreement is continuation of the earlier contract entered at
the time of joining to the duty with conditions.
(iii) The appointment is solely on contract basis and never be considered for
regularization.
(iv) The Transfer from one place to another is not permissible.
(v) The contract can be renewed for next financial year based on the
performance and after one day break of service on first 1 April as per
bond executed.
(vi) This is a full time assignment. Hence, the working hours shall be as
applicable for regular employees under NHM.
He / She should report to the Health and Wellness Centre by 9.00 am
and work till 5.00 pm on working days.
He / She is permitted to avail General Holidays as notified by the
Government, however Shall work for half a day on Second and fourth
Saturday i.e 9.00 am to 1.00pm. And also as per the instructions of
Higher authority for special purposes

(3) The Leave Leave eligibility:

eligibility and
Travel (i) The Mid-level Health Care Provider for Universal Health Coverage is

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 allowance eligible for 15 days of casual leave in a year. The leave can be availed
on Pro-rata basis being eligible for one day casual after working for one
month with addition on one day casual leave at the end of 4 completed
months. The accumulated leave can be availed as per the leave to his/her
credit within the calendar year or contract period.
(ii) The Mid-level Health Care Provider for Universal Health Coverage can
avail 10 days of medical leave during the year. If the leave availed is
more than 2 days continuously, submission of medical certificate from a
Registered Medical Practitioner is mandatory.
(iii) The above leaves are applicable for the contract period only, and cannot
be carried forward.
(iv) A Female Mid-level Health Care Provider is eligible for maternity
leave as per prevailing norms of District Health Society.
(v) A male Mid-Level Health Care Provider is eligible for paternity leave as
per prevailing norms of District Health Society.

Travel allowance :

(i) TA/DA will be admissible as per norms of the District Health & Family
Welfare Society for attending meetings and other official duties
authorized by appropriate authorities from time to time.

(4) Payment A. Ceiling:

(i) For Services rendered pursuant to TOR, the Client shall pay the Mid-
level Health Care Provider a monthly remuneration of Rs. 24,200/-
(Rupees Twenty Four Thousand Two Hundred only) in Hyderabad
Karnataka Districts, HPDs and Rs. 22,200/- (Rupees Twenty Two
Thousand Two Hundred only) in Non -Hyderabad Karnataka Districts.
Performance based incentives of maximum of Rs. 8000/- will be paid
as per the performance of MLHPs for the Specific deliverables.

(ii) There shall be Tax Deduction at Source (TDS) as per applicable laws.
All other tax liabilities and responsibility for remittance with statutory
authorities are that of the Mid-level Health Care Provider, except that of
TDS.
(iii) It shall be the responsibility of MLHP to maintain relevant records of
deliverables for determining his/her performance.

B. Terms of payments:
Monthly Remuneration shall be paid based on the detailed monthly
work diary and study / evaluation reports as per TOR accepted by the
designated officer of the client.

(5) Supervision and The Client designates District Surveillance Officer (DSO) as Client’s
Monitoring. District Coordinator; the Coordinator shall be responsible for the coordination
of activities under the Contract. The coordinator will be responsible for
acceptance and approval of deliverables performed by Mid-level Health Care
Provider, UHC and for receiving and approving invoices for the payment.
However the MLHP shall work under the overall supervision of concerned
Taluk Health Officer and jurisdictional PHC Medical Officer.

(6) Ownership of (i) All records and any study report or other material, graphic, software or
Material otherwise, prepared by the Mid-level Health Care Provider for the Client
under the Contract shall belong to and remain the property of the Client.

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 (ii) The Mid-level Health Care Provider shall, at the time of closure /
termination of Contract, shall handover all records including soft copy and
e-mail accounts / correspondence used for official purpose.

(7) Confidentiality The Mid-level Health Care Provider shall not, during the term of this Contract
and within three years after its expiration, disclose any proprietary or
information relating to the Services, this Contract or the Client’s business or
operations without the prior written consent of the Client.

(8) Performance The Mid-level Health Care Provider undertakes to perform the Services with
Standard the highest standards of professional and ethical competence and integrity.

(9) Mid-level Health The Mid-level Health Care Provider agrees that, during the term of this
Care Provider not Contract and after its termination, the Mid-level Health Care Provider and
to be engaged in any entity affiliated with the Mid-level Health Care Provider, shall be
certain activities disqualified from providing goods, works or services (other than the Services
or any continuation thereof) for any project resulting from or closely related
to the Services.

(10) Insurance The Mid-level Health Care Provider will be responsible for taking out any
appropriate insurance coverage.

(11) Assignment The Mid-level Health Care Provider shall not assign this Contract or Sub-
contract or any portion of it.

(12) Law Governing The Contract shall be governed by the laws of land, and language of the
Contract and Contract shall be English. The Jurisdiction will be Bengaluru.
Language

(13) Termination The Client may be suspended immediately if fails to pass Bridge Programme
Course Certificate in Community Health (BPCCHN) in the 1st attempt till he
passes in the immediate second attempt with in six months. No financial
assistance / benefits will be given during the period of suspension.

Suspension may be revoked if he/ she clear the exams in the immediate
second attempt else his / her contract may be terminated with immediate
effect. The client may terminate this contract with immediate effect, if Mid-
Level Healthcare Provider fails to Pass the Certificate in Community Health
(CCHN) in the immediate 2nd attempt.

After successful passing his suspension will be revoked and the client will be
entitled for financial benefits.

The Client may terminate this Contract with at least thirty (30) Calendar days’
prior written notice to the Mid-level Health Care Provider after the occurrence
of any of the events specified in paragraphs (a) through (d) of this Clause or
one month’s remuneration in lieu thereof;

(a) If the Mid-level Health Care Provider fails to remedy a failure in the
performance of his/her obligations hereunder, as specified in a notice of
suspension pursuant to Clause 13;

(b) If the Mid-level Health Care Provider becomes insolvent or bankrupt;

(c) If the Mid-level Health Care Provider in the judgment of the Client has
engaged in corrupt, fraudulent, collusive, coercive, or obstructive practices

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 in competing for or in performing the Contract.

(d) If the Client, in its sole discretion and for any reason whatsoever, decides to
terminate this Contract.

(e) The Mid-level Health Care Provider can also terminate the contract as per
the conditions in bond executed.

(f) If second party renders resignation, then the appointing authority will be
guided by conditions of bond executed/ guidelines issued by the
government for time to time, without causing loss to the Government.

g) If the Mid-level Health Care Provider provides duplicate document or joins

to any new job by creating duplicate documents, then they are liable for
criminal action also along with termination.

With above a, c, e, f & g conditions the Mid-level Health Care Provider can be
terminated with recovery of the Bond amount i.e Rs. 2.5 lakhs only
(Rupees two lakh and fifty thousand only) by the Client . Till such time or
up to 3 years or solving of the matter concerned to Bond period the
original documents of the Second party shall be kept by the Client at the
time of execution of contract Bond .

(14) Dispute Any dispute arising out of this Contract, which cannot be amicably settled
Resolution between the Parties, shall be referred to Principal Secretary to Government of
Karnataka, Department of Health and Family Welfare, whose decision shall
be final and binding on both the Parties.

IN WITNESS whereof the said Parties have set their hands on the date referred in the first
paragraph above.

District Health & Family Welfare Officer, Mid-level Health Care Provider
District Health Society

WITNESS:
1) 2)

Annexure II

Terms of Reference with Scope of Services for Mid-level Health Care Provider(MLHP)
Working under CPHC-UHC Program.

1. Objective:

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 The objective is to provide implementation support to the Comprehensive Primary Health Care
(CPHC) initiative of National Health Mission (NHM), Directorate of Health and Family Welfare
Services, Government of Karnataka and to establish comprehensive management system, which
delivers effective comprehensive primary health care services through creation of Health and
Wellness Centres at every Health Sub Centre; and to train Junior Health Assistants male and
female and a group of five ASHAs. He/she is also expected to support field visits, screening of
entire population for NCD’s, creation of EHR of the population served by the sub centre,
providing the counselling services.

2. Scope of work:

The Mid-level Health Care Provider shall implement Comprehensive Primary Health Care under
the guidance of District Surveillance officer with technical support from TILC of Public Health
Foundation of India.

The Nurse Mid-Level Provider is expected to perform the following functions:

i. Clinical Functions:
 Detect and manage problems during pregnancy and postpartum period using guidelines
and protocols and refer complicated cases to designated PHC or appropriate healthcare
facility (FRU) for further management.

 Identify and manage problems of new born using guidelines and protocol. This would
involve basic stabilization and referral to appropriate healthcare facility (FRU/SNCU) for
further management.

 Detection and treatment of anaemia and other deficiencies in children and adolescents,
early detection of growth abnormalities, delays in development and disability and
undertake adolescent health- counselling, and referral as per need.

 Diagnose and manage Common Communicable Diseases and General Out-patient care
for acute simple illnesses and minor ailments. These include common fevers, ARIs and
diarrhoeas, and skin infections. (scabies, abscess), common aches, joint pains, common
skin conditions,(rash/urticaria)Indigestions, gastritis and Acute febrile illness.

 Provide family welfare services to couples in planning their families.

 Undertake basic diagnostics(blood sugar, BP screening, urine testing for albumin, sugar,
RDK and smear testing for malaria, collection of sputum for TB Microscopy, skin smear,
vaginal smear, visual inspection with acetic acid (VIA) or Leugol’s Iodine as
recommended by National/State Guidelines for screening of cervical cancer)and
collection of blood samples and transport to labs for further diagnosis.

 Screen and refer patients for confirmation and initiation of treatment to PHC Medical
Officer for non-communicable diseases-Diabetes, Hypertension, Asthma/COPD, joint
pains/arthritis and epilepsy to begin with. As the programme matures, the Nurse Providers

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 would be trained in new set of competencies and can be expected to undertake screening
and management of other NCDs.

 Screen and refer for infectious and oncological conditions of women viz. STI/RTI,
HIV/AIDS, breast cancer, uterine cancer and cancer cervix.

 Detect and refer cases of mental illness, follow up medication, counselling/support

confirmation and referral for de-addiction and manage violence related concerns.

 Identify and treat common eye problems- conjunctivitis; spring catarrh, xerophthalmia,
first aid for injuries, referral and manage common colds, Acute Suppurative Otitis Media ,
injuries, pharyngitis, laryngitis, rhinitis, Upper Respiratory Infections and sinusitis.

 Screen and refer for gingivitis, dental caries, oral cancers and provide treatment for
glossitis, candidiasis (look for underlying disease), fever blisters and aphthous ulcers;

 Initiate first aid and emergency care, and refer to appropriate health care setting.

 Undertake follow ups for patient initiated on treatment at higher healthcare facilities-
PHC/CHC/TLGH or Medical College, dispense drugs/ensure refills and adherence to the
treatment plan.

ii. Public Health Functions:

 Provide health education, counselling and promotional activities across the age groups
and ensure that VHNDs are observed in all villages as per the guidelines.

 Plan, organize and implement National Health Programmes in the community and at the
HWC for every 5000 population.

 Investigate epidemics and follow up public health problems at the village level

 Facilitate health insurance coverage for households covered in the HWC area and inform/
educate the members enrolled in HWC about the service packages, eligibility criteria and
procedure of availing claims or reimbursements under insurance schemes such as- RSBY,
ESIC, Yeshaswini or Vajpayee Arogyashree. This is to support the population in availing
the secondary/tertiary health care not available in public health institutions from
empanelled hospitals and minimize the chances of financial risk to the families due to
healthcare costs.

 Support Medical Officer, in management of Epidemics, Community based assessment for

NCDs, and obey the instructions of Medical officer for duty guidelines.

iii. Training/Mentoring Functions:

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  Support the HWC team in undertaking detailed mapping and enrolment of the population
through household survey and provision of Unique Health ID for the household

 Handhold JHAs and ASHAs in undertaking health risk assessments for population
groups. This includes health risk assessments for adults, paediatric groups, pregnant,
postnatal mothers and newborn, Geriatric, mental and dental health assessment.

 Provide technical guidance and supportive supervision for the work of Junior Health
Assistants and ASHAs serving in the designated area of the Health and Wellness Centre
for providing outreach care.

 Support the work of ASHAs and the VHSNCs for action on social determinants for health
through a process of review and planning including with frontline workers and
supervisors of other related social sector programmes.

iv. Record Keeping and reporting functions:

 Maintain patient records, family health folders, health risk assessment data and treatment
details for enrolled patients of HWC in a computerized data base.

 Prepare monthly reports for service delivery comprising of details such as monthly out-
patient figures, follow ups and referral undertaken, high risk cases managed and referred,
disease wise statistics of cases attended at Health and wellness centres and other records
as specified by the Department of Health and Family Welfare.

 Undertake inventory management and maintain records for drugs and consumable and
other supplies, streamlined drug indent and ensure minimum three months stocks for
essential drugs.

Working Arrangements/Terms and Conditions:

 The MLHP is expected to work from 9:00am to 5:00pm for provision of outpatient care at the
HWCs with Lunch break from 1:00pm to 1:45pm.
 MLHPs should work from 9:00am to 1:00 pm on Second and Fourth Saturdays and also on
special occasions.
 MLHPs should wear apron during the duty hours compulsorily.
 MLHPs will report to the Medical Officer of the PHC to which the particular HWCs has been
assigned to.
 MLHPs will attend the monthly review meeting conducted by Medical Officers of PHC.
 Performance based incentives will be calculated after assessing the MLHPs performance as per
the Performance Based incentive criteria by the Medical Officer of the PHC and submitted to
District by THOs after verification. DSO and DHWC coordinators will evaluate and finally
PFMS will be done to MLHPs account.
 Salary of MLHPs will be released after the submission of duly signed attendance and work
diary by Medical Officer of PHC, attested by THO.

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  MLHPs will participate in in-service training programmes that are a mix of theory and
practicum and undertake a qualifying examination. Failure to obtain the requisite marks and
demonstrate good performance in the examination will result in termination.
 MLHPs will assess and manage common health problems in the population covered in the Sub-
Centre area, provide basic first aid for the emergencies, screen, detect, refer patients with
chronic, infectious illnesses and follow up for the treatment under supervision of the PHC
Medical Officer.
 MLHPs will lead a team of frontline workers - ANMs, ASHAs and AWW through a process of
support and mentoring ensure the achievement of health goals for the H&WC.
 The selected candidates are to reside compulsorily in the block and not more than 10 Kms
radius from the place where the Health Sub-Centre is located and provide services as and when
asked for.

Key Deliverables:
 Delivery of all listed 12 service packages of Health and Wellness centres.
 Engage with the ANM, ASHA and MPW’s in the effective service delivery for RMNCH+A,
CD, NCDs, General ailments and other National programme management.
 Coordinate including administration, liaison, and logistics, organizing meetings at the state and
HWC level.
 Any other project related duties assigned by the District Health and Wellness Coordinator/
THOs/MO PHC.
 Undertake any other tasks and responsibilities assigned by Superior Officers directly or through
District Health and Family welfare officer from time to time.

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