uttrakhand health system nrhm

7/27/2019 Uttrakhand Health System NRHM

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Team 1



MINISTERGOVERNING

BODYSECRETARYEXE.DIRECTORSECRETARY

DIRECTORGENERAL

DIRECTOR UPPER DIRECTOR

Joint DirAIDS

Joint Dir.RCA-1

Maternalhealth

Joint Dir.RCA-2ChildHealth

Joint Dir.T.B

Joint Dir.Leprosy

Joint Dir.EYE

JointDir.

HIMS

Jointdir.I.E.C

I.E.COFFICER

Finance cont.



Minister: Head of all health activity running at the

state level.

There is Governing Body (IAS Officer) headed by theHealth Minister.

Secretary: Works under IAS officer.

The Executive director is leading the executive

committee.

Secretary: Works under Executive director and isresponsible for implementation of programs.



Position of Director general is divided into threeparts:

A director for National Programs.

A director for health and family welfare.

A director for finance.



Director for National Programs

Upper director works under National Programsdirector.

It is divided into eight departments: Joint director RCH-1 (Maternal health)

Joint Director RCH-2 (Child health and immunization-IMMCI) Joint Director of T.B

Joint Director of Leprosy

Joint Director of Eye

Joint Director of ICE- Under this IEC officers are working

Joint Director of HIMS;

Joint Director of AIDS



DirectorMedical &

health

Upper dir.Administrati

on

Upper dir.Medic.Edu.

Upper Dir.Store

UpperDir.

Health

Upper dir.Medical

treatment

Upper dir.Employer

Jointdir.Dru

g &logistic

Drugcontroller

Jointdir.IDSP

Joint dir.Health

DeputyDir.

MedicalOfficer

Joint dir.

Medical

Treat.

Assist.Dir.

Medicalofficer

Joint dir.PPP

Assist.Dir.

Joint dir.

faculty

DeputyDir.

Nursing

Deputy Dir.

Drug



The six Directors are as follows:

Upper director (Administrative officer) Upper director of Medical and

education

Upper director of store Upper director of health

Upper director of medical treatment

Upper director of employer



Upper director(administrator)-under which all administrative work

takes place.

Upper director(medical education)-it helps to promote the medicaleducation.

Upper director of store-under this all drug related such as storageand quality related work is done.

Upper director of health-it helps to prevent communicable and

non-communicable disease, disaster management etc. Upper director (medical treatment)- under this all functions related

to treatment such as EMRI, Smart card policy, Mobile etc aregoverned by them.

Upper director (employer)-under this some employer are working

and some of the engineers are also working. They help to maintainthe infrastructure.



Upper director of store:

The department of store is divided into further two moredepartments:

Joint director of drugs and logistics

Drug controller

Upper director of health:This department is further dived into two departments:

Joint Director (IDSP): It work on the communicable and non-communicable diseases

Joint Director of Health: It works on Vector born disease andEpidemic disease.



Some others works include :

Disaster Management

Food License

Birth and Death Certificate Registrations.

Under the joint director of health two more

departments are working:

Deputy Director (Birth and Death)

Medical Officer.



Upper Director of Medical Treatment:

It is further divided into three parts:

Joint director of medical treatment: under thisassistant director works n under him medicalofficer works.

Joint director of PPP- Under this followingfunctions are done:

EMRI, Smart Card, Health policy, Mobile VanServices

Joint Director of faculty: It is further divided into

two groups: Deputy Director of Nursing

Deputy Director of Pharmacy.



Joint Dir.Of

Administration

Joint Dir.Of

Staff officer

Joint dir.Of

Trainee

Joint dir.Of

Dental

Assist. Dir.Of

Administration

Legalofficer

Assist. Dir.Of

Trainee

Assist. Dir.Of

Dental



It is further divided into following groups:

Joint Director (Administrative)

Joint director (Staff Officer)

Joint Director (Training):The traineedirector has an Assistant director whoworks for him.

Joint Director(Dental): An Assistant

Director works under him.



Under joint director of administrationassistant director of administration works.

Legal officer works under the assistantdirector who helps in the court cases and thevehicle storage power.



CMO (chief medical officer)

Deputy CMO for

urban setup(DCMO)

Deputy CMO for

rural setup(DCMO)

Administrative

officer

Medical officer (PHC) Medical Superintendent (CHC)

LHV (lady health visitor) (SC)



CMO (chief medical officer):- •Overall charge of general administration

•Discipline of medical department with smooth delivery of health care comes

under CMO.

•He is responsible for taking budget estimate every year and submits the

report to higher hierarchy.

•He will accompany chairperson on his inspection whenever required.

DCMO (Deputy Chief medical officer):- •He reports to CMO and assists him/her in the administrative department and

is responsible for controlling the expenditure by following the budget.

•Drugs imprest charge is under DCMO

•He is the one who passes LTC claims of staff at medical department.



Administrative officer:- •He is a non-technical head of CMO office and will be directly responsible for the clerical work of the entire office.

•He assists CMO in general administration and discipline of official staff and

can attend to any other works as assigned by DCMO/CMO from time to time.

Medical superintendent (CHC):- •Medical superintendents have to hold current registration with medical board

or appropriate body (i.e. district hospitals) in category for which they are

employed and are also responsible for ensuring good clinical governance.

•MS includes executive directors of medical services and district directors of

medical services.



Medical officer (PHC):- •In addition to diagnostic and curative services medical officer acts as a

primary administrator at PHC level and reports everything to districtheadquarters.

• Qualification of Medical officer must be an MBBS.

LHV (lady health visitor) (SC):- •LHV is entrusted with the task of supervision of 6 SC and reports to

medical officer (PHC) about SC annual reports.

•She provides a variety of services to urban and rural communities,

including basic nursing care, maternal child health services and training of

community workers.



Also called as ‘Sehat ki sawari ’ .

This project have started in 2 districts-

*TEHRI- launched on 27th October 2005

*CAHMOLI- launched on 17th October 2004

OBJECTIVE:

To initiate health care access to remote areas.

MANPOWER:

Physician- 1, Pharmacist-1, IEC assistant-1, Nurse-1,

Lab technician-1, Attendent-1, Project coordinator-1,

Driver-1.



Health Indicators Uttarakhand India

Crude Birth Rate 20.4 23.1

Crude Death Rate 6.8 7.4

Total Fertility Rate 2.6 2.7Maternal Mortality Rate 440 254

Infant Mortality Rate 48 55

Child Mortality Rate 57 72

Neonatal Mortality Rate 28 44



Total fertility rate almost same to nationalaverage.

Infant mortality rate , Child mortality rate &Neonatal mortality rate are also below thenational average .But , Maternal mortality rate is very high (almostdouble).It is one of area of concern.

Overall heath status is satisfactory.



Socio & Demographic Profile Uttarakhand India

Total Population(in millions) 10.12 1210.20Rural Population(in millions) 7.28 730.75

Urban Population(in millions) 2.83 281.37

Decadal Growth(%) 20.4 17.64

Population below povertyline(%) 31.8 27.5

Density (Person per sq. km) 189 382

Sex Ratio 963 940

Schedule Caste Population(%) 18 16.2

Schedule Tribe Population(%) 3 8.2

Literacy Rate(Person) 79.63 74.04

Literacy Rate(Male) 88.33 82.14

Literacy Rate(Female) 70.70 65.46



Low population density(189/sq.km). But , population growth in decade is more

than national average.

Population below poverty line is more thannational average.

Sex ratio is in good condition.

Literacy rate is more than national average.

Overall we can say that socio economicprofile of the state is satisfactory.



Public Health Infrastructure Uttarakhand India

Number of District Hospital 18 635

Number of FRUs 16 2463

Number of CHCs 55 4535

Number of PHCs 239 23673

Number of SCs 1765 147069

Average Rural Population

covered by CHC

114732 163725

Average Rural Populationcovered by PHC

26403 31364

Average Rural Populationcovered by SC

3575 5049

Average Rural area covered byCHC

957.93 687.61



Public Health Infrastructure Uttarakhand IndiaAverage Rural area covered by PHC 220.44 131.72

Average Rural area covered by SC 29.85 21.20

Average Radial distance covered by CHC 17.46 14.79

Average Radial distance covered by PHC 8.38 6.47

Average Radial distance covered by SC 3.08 2.60

Average Number of villages covered by CHCs 306 141

Average Number of villages covered by PHCs 70 27

Average Number of villages covered by SCs 10 4

Number of SCs per PHC 7 6



Accessibility of these centre are also difficultbecause area are hilly & average radialdistance is high.

For example radial distance covered by PHC is

17.46 km(national average is 14.79 km). Also as Uttarakhand is hilly place which

make it more difficult. So there is need to increase the number of

health care institution. Here another important factor is the location

of establishment.



A LOOK AT THE FIELD VISITS GROUP NO. 1



4th Aug’11 : CHC,Bassi

5th Aug’11 : a) PHC,Tunga



9th Aug’11 : DH,Dausa



It is headed by a PMO

Total no. of beds: 150

Population covered: 20 lac

No. of OPD/day: 500-600

IPD/day: 80 All major services available.



All type of general surgeries performed

Total 35 doctors are present

Deliveries done under JSY/day: 10

Yashoda & Priyadarshani are available

Blood bank functional & blood donationcamps held per month



All diagnostic & investigation facilitiesavailable except MRI

Laboratory & O.T. is well equipped

Special cases are referred to SMS, Jaipur

Provisions for BPL are adequate

Enquiry counter & STD clinicpresent.



Pharmacy with all kinds of drugs includingayurvedic, homeopathic & unani drugs ispresent

1 public health manager is present

Family planning checkups done by doctors onroutine basis through field visits



Nursery is present

14 incubators are available & usually all of them are occupied

Mostly cases of jaundice, low birth weights, &malnutrition are reported

Labor room present with 50 beds & 4 doctors



No. of caesarian cases done in past 7 months:25

12 AYUSH nurses are available (3 morning, 3evening, 3 night, 3 rest of the time)

Total 35 ASHAs are present but only 20 are

working

Emergency room is present



No fee for bed.

Rates of OPD: Rs 5, IPD: Rs 20, X-ray: Rs 60,USG: Rs 200(full abdomen) & Rs 120(specificpart)

Total no. of ambulance: 2

Eye OPD with 2 eye testing machines present Medical camps are frequently organized by

NGOs



4 X-ray machines & 1 USG machine availabl

Centrally air-conditioned ICU in neonatalward

Round-the-clock electricity & water supply

Easily accessible location



No ICU & sterilization room

1 dental chair in dental OPD, & that too non-functional

No pediatric surgeon & dermatologist available

Physiotherapy services not provided

No diet provided to indoor patients, except milk



Labor room is over-crowded, increasedchances of hospital-borne infections inneonates

Used syringes are disposed undestructed just outside the hospital premises

Waste disposal not done as per thegovernment guidelines

S. No. Personnel IPHS norm Current



Availability

1 Hospital Superintendent 1 1

2 Medical specialist 3 1+1

3 Surgery specialist 2 2

4 Obs & Gynae specialist 4 4

5 Psychiatrist 1 1

6 Pediatrician 2 3

7 Anesthetist 2 1

8 ENT surgeon 1 2

9 Ophthalmologist 1 1

10 Orthopedician 1 1

11 Radiologist 1 1

12 Casualty/ General dutydoctors

6 16

13 Dental surgeon 1 1



Major specialist services available.

Population covered: 25,ooo

No. of beds: 30 (10 males & 20 females).

Bed occupancy rate is high due to servicesprovided.

Avg. OPD: 600 (IPD- 25)/day



Essential laboratory services available: BT,CT,Hb, WIDAL, Dengue, AFB, Blood sugar.

All vaccination & immunization services areprovided by trained staff under doctor’ssupervision.

Waste disposal done by health care wastemanagement on alternate days



Free medications given by MRS to BPL sector,widows and physically disabled.

Kitchen is unavailable, but food is providedby JSY.

Special cases referred to SMS, Jaipur. Gynaecases are referred to Mahila chikitsalaya whilepediatric cases to Jan Kalyan Hospital.



Equipments like X-ray & USG machines,Incubators, Centrifuge machine, Autoclave,Hot air oven are available



HIV counseling and promotional desk available.

Patient education regarding Malaria, TB, blood &eye donation, breast feeding is done.



Fees: OPD- Rs 2, IPD- Rs 5, ECG- Rs 30,USG- Rs 165, Dengue- Rs 240, X ray- Rs 60

Full time electricity and water availability.

Positive patient feedback regarding Doctor’sservices.

Block CMO and NRHM health manager deskavailable.



500-600 deliveries per month,butonly 1 gynae available.

Non availability of full time

Anesthetist, eye surgeon, publichealth program manager.

Drinking water source unhygienic.

Blood bank nonfunctional



Overall cleanliness and

hygiene unsatisfactory.

Building is underconstruction due toexpanding infrastructure,may lead to someaccident..

Electricals and circuits

uncovered.

Lack of ventilation andsanitation facilities.

S. PERSONNEL IPHS CURRENTAVAILABILIT



no. normY

1 General surgeon 1 1

2 Physician 1 1

3 Obstetrician /Gynecologist 1 1

4 Pediatrician 1 1

5 Anesthetist 1 -

6 Public health programme manager 1 1

7 Eye surgeon 1 -

8 Medical officer 4

9 ANM 1 3

10 Nurse/Midwife & Staff nurse 7 5

11 Wardboys 2 10

12 Data entry operator1 1 1



All facilities are available(proper datahandling, proper store, laboratory & labourroom)

Total OPD: 90-100/day

No. of beds: 6

Other services like nutrition services andschool health programmes are also available



Labor room is available and deliveries are conducted there. JSY also is also being applied.

ASHA is employed as well as trained there. ANM also present



A day for immunizationis fixed and the sessionsare held as pergovernment guidelines.

Residential facilities

available for femalehealth workers.

Lab equipped withmicroscope, tests are

carried out for malaria &TB but not for HIV



Patients are referredto: CHC, Bassi

TB centre, ShastrinagarMedical college, Jaipur

National programmesavailable: AIDS controland TB control

program. Save the girlchild program also inprogress.

Quarter for AYUSHis available but



is available butservices are notprovided.

Hospital wastebeing dumpedwithin premises.

Overall cleanlinessis good but not inlabor room.

Pharmacy for drug

dispensing andstorage is notavailable.

S. No. Personnel Recommended Current



Availability

1 Medical officer 2( one may beAYUSH & onemay be Lady

M.O.)

2

2 Pharmacist 1 1

3 Nurse- midwife(staff nurse) 3( one foe24hrs and 2 oncontractualbasis)

1 ANM2 GNM

4 Health worker(female) 1 -

5 Health educator 1 -

6 Health assistant 2 6

7 Lab technician 1 1



Population covered: 5,000 Immunization sessions held as per

government guidelines.

Family planning checkups & survey done on

routine basis.

Ante natal care services delivered.

First aid services provided.

Free distribution of oral contraceptives.



Drugs like PCM, citrizine, metrogyl, & DOTSavailable.

ORS given to children suffering fromdehydration & diarrhea.

Co-ordinated services with AWWs, ASHA,Village health & sanitation committee areprovided.

1 health worker & 1 nurse present.

Overall infrastructure is satisfactory.



GROUP NO. 1

uttrakhand health system nrhm

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