Download - Uttrakhand Health System NRHM
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Team 1
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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.
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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.
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Position of Director general is divided into threeparts:
A director for National Programs.
A director for health and family welfare.
A director for finance.
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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
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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
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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
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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.
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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.
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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.
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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.
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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
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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.
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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.
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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)
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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.
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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.
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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.
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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.
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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
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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.
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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
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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.
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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
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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
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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.
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A LOOK AT THE FIELD VISITS GROUP NO. 1
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4th Aug’11 : CHC,Bassi
5th Aug’11 : a) PHC,Tunga
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9th Aug’11 : DH,Dausa
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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.
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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
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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.
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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
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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
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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
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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
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4 X-ray machines & 1 USG machine availabl
Centrally air-conditioned ICU in neonatalward
Round-the-clock electricity & water supply
Easily accessible location
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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
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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
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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
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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
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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
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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.
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Equipments like X-ray & USG machines,Incubators, Centrifuge machine, Autoclave,Hot air oven are available
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HIV counseling and promotional desk available.
Patient education regarding Malaria, TB, blood &eye donation, breast feeding is done.
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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.
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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.
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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.
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GROUP NO. 1