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GOVERNMENT
OF ANDHRA PRADESH
ABSTRACT
APM&HS
– DPH&FW – Effective functioning & service delivery of Primary Health
Care in Sub-Centres / PHCs / CHCs and Roles & Responsibilities of Dy.
DM&HOs in CHNCs (Clusters) under the administrative control of DPH&FW –
Framing & Preparation of certain guidelines & Procedure for effective
implementation – Orders Issued.
HEALTH
MEDICAL AND FAMILY WELFARE (B1) DEPARTMENT
G.O.RT.No.
602 Dated:28-09-2015
Read:
From
DPH&FW, A.P. Hyd. Lr.Rc.No.379/Plg.D/2015, dt.15-9-2015.
* * *
ORDER:
In her
letter read above the DPH&FW, A.P.
Hyd. has stated that there are thousands of Sub-Centres and Hundreds of PHCs /
CHCs and Clusters functioning with lot of Medical & Para Medical and filed
supervisory staff in the State so as to enable to deliver effective services to
the down trodden / poor people living in rural and tribal areas.
2. All the Sub-Centres are functioning under
the Administrative control of CH&FW, where as the PHCs / CHCs and CHNCs
(Clusters) are being functioned under the administrative control of DPH&FW.
3. For effective functioning of all these
Sub-centres / PHCs / CHCs and CHNCs and effective service delivery of Medial.
Para medical staff & Filed Supervisory staff working in all the said
institutions and with a view to have prompt vigilance & effective
supervision over the said institutions, the DPH&FW, A.P. Hyd. has opined
that it is necessary to issue certain guidelines for effective functioning of
said institutions and certain instructions for effective service delivery of
Medical and Para-medical and supervisory staff working therein and also to
issue certain clear instructions regarding the Roles & Responsibilities of
all the Dy. DM&HOs in the CHNCs (Clusters) in the state for effective
supervision over the said institutions and staff working there.
4. Government of careful examination hereby
accord permission issued the following guidelines with immediate effect.
I. GUIDELINES FOR SUB-CENTRE
STAFF&SUPERVISORY STAFF FOR EFFECTIVE SERVICE DELIVERY:-
Ø All sub center
staff should stay in their Head Quarters.
Ø Sub-center
should be kept open from 9Am to 4Pm.
Ø In any
circumstances SC should not be closed before 4Pm.
Ø All the staff of
SC should be in Dress code with the Identity card at
Facility & at field.
Ø All the IEC
related to MCH Services, Water born & Vector born diseases should be displayed.
Ø MPHA(F) 1
–Ensure that all Medicines required to provide First-Aid Medical services to be kept in
sufficient quantities. Should maintain the
Drug stock Register,Equipment Register and see that the required equipment should be present in
functional status like-
1.Thermometer
2.BP apparatus
3.Sthethescope
4.Weighing Machine
5.Baby Weighing scale
6.Haemoglobinometer
7.Test kits for
Pregnancy&Malaria
8.Tickly bag
Staff of SC
should know how to Record BP and Testing of Heamoglobine
Ø
MPHA(F) 1&2 Should provide mainly the services
of MCH and in addition to other services as per the requirement and need.
Ø
MPHA (F) 1&2 Should maintain the Tablet given
for the updating of MCTS in good working condition and should not be handed
over to any other person for any purpose
Ø MPHA(M) Should
provide the services related to Water born & Vector born diseases
Should see the Sanitation, Cleaning and
Chlorination of all Overhead Tanks & Wells, rectification of any pipeline
leakages of water sources in Co-ordination with Panchayathi Raj &RWS Dpts.
every 15 days and the date of chlorination should be recorded on the Over head
Tanks & Wells.
Should send the IDSP Reports on time & if any
alarming situation in his area immediately to be informed to Medical officer
& Dy.DM&HO concerned through Telephonic Message. Maintain the records
of Diseases as per P Forms.
Ø MPHS(F) Should
assist and supervise the work of MPHA (F),check the Skills, Verify the records
weekly once, duly signing in all the registers.
Randomly verify the beneficiaries in the field and
should sign in the MCP cards after verifying the entries made by ANM.
Should
submit report to the Medical Officer once in 15 days.
Ø MPHS(M) Should
assist and supervise the work of MPHA(M) verify the records weekly once related
to Chlorination duly signing in the register and randomly verify in the field
reg. recording of Chlorination of Overhead Tanks& Wells and submit report
to Medical Officer once in 15 days.
II. GUIDELINES FOR PHC / CHC STAFF FOR EFFECTIVE
SERVICE DELIVERY:
1. All PHCs / CHCs staff should stay in
their Head Quarters.
2. All PHCs / CHCs should be kept open
from 9.00 to 4.00 PM and for 24 hours in 24x7 Institutions. Under any
circumstances the PHC/CHC should not be closed in the specify timings.
3. All the staff should attend the
duties on time with a grace period of 15 minutes.
4. All the staff including medical
officers should maintain dress code with the ID card while on duty at the
facility and at field work.
5. Sanitation and greenery should be
maintain in and around the Hospital premises.
6. All IEC related to all National
Health Programmes should be displayed at the reception area.
7. Display of the following at
reception area:
i.
Citizen Charter
ii.List of
availability of Essential Medicines with update of the stock.
iii.
List of services available.
iv. List of Laboratory services
available.
v. Complaint box/ Suggestion box
should be available at the
reception area.
(a)
JOB CHART OF PHARMACISTS:
1. The Pharmacist should ensure that
all the Medicines and Vaccines required for the PHC should be made available in
sufficient quantities.
2. He Should maintain the BIN CARDS,
Drug Stock Register, Drug Watch Register, Equipment Register, ILR Temperature Chart.
3. He should ensure that all equipments
are in good and functional status.
4. He should take the signature of the
Medical Officer every 15 days in the all the registers after due update.
5. Should update C-DAC and SCM entries
daily.
6. Any problem related to the job chart
should be brought to the notice of the Medical Officer for rectification.
7. If Medical Officer is on tour
Pharmacist should dispose of the OP related to common ailments with the
prescriptions advised by the Medical officer .
(b) JOB CHART OF LAB TECHNICIAN:
1. Should maintain the Laboratory Clean
and tidy.
2. The Lab Technician should ensure
that all Material and Reagents for the laboratory test are available in
sufficient quantities.
3. Should maintain Laboratory equipment
in good working condition.
4. Should perform the laboratory tests
as per the standards prescribed for the diseases.
5. If any problem related to the
functioning of the Laboratory should be
brought to the notice of the Medical Officer for rectification.
(c) JOB CHART OF
HEAD NURSE / STAFF NURSE:
1. Should ensure that the Labour Room
and the Operation Theatre should be kept clean and tidy. Fumigation to be done
periodically.
2. Delivery table should be maintained
properly.
3. New born care corner and Baby warmer
should be maintained properly.
4. To ensure that all the IEC related
to Stages of Labour, Partograph, Early initiation of Breastfeeding, Zero dose
Immunization, Safe Child Birth Checklist(SCC), Active Management of 3rd
stage of labour should be displayed/Painted properly in labour room.
5. Atleast 3 sets of Autoclaved
delivery kits and new born baby kits should be available for ready use.
6. Emergency drug tray should be
maintained with all the required medicines after duly checking the expiry
dates.
7. Oxygen cylinder should be available
in full working condition.
8. Anti-septic lotion / soap should be
available for Hand wash at Washing area.
9. Staff Nurse should maintain the
parturition register properly.
10.
The
Head Nurse should verify all these things daily and maintain the check list of
all the things. She should see that all staff nurses are regular to their
duties as per their duty roster.
11.
They
should conduct not less than 5 deliveries/month in Regular PHCs, not less than
10 deliveries/month in 24x7 PHCs and not less than 30 deliveries/month in CHCs.
12.
Anticipate
the risk for the pregnant patient early and refer them well in time to the
appropriate nearby Referral centre with Escort duly informing the Referral
Hospital In-charge.
13.
Staff
Nurse should take the signature of the Head Nurse and Medical Officer every day
in the Parturition register and Referral register.
(d) JOB CHART OF
PHN:
1. PHN should assist the Medical
Officer in conducting Ante-natal OP.
2. Should explain all the Pregnant
women on the importance of Hygiene, Nutrition, Early initiation of
Breastfeeding, Birth Spacing and on Temporary Family Planning Methods.
3. Ensure that the Sub centre wise list
of High Risk Pregnant women and Monthly EDD List should be displayed at
Reception area.
4. Should verify the tour dairy of
MPHS(F) every 15 days duly signing in their tour dairy.
5. Should visit all the sub-centres
once in 15 days and verify the field registers of ANMs duly singing in them and
randomly checking of beneficiaries in the field and submit the report to
Medical Officer once in 15 days.
6. Should assist the Medical Officer in
conducting the Maternal Death and Infant Death review.
(e) JOB CHART OF
CHO:
1. Should assist Medical Officer in
preparing the monthly reports and conducting the monthly review meetings with
the field staff.
2. Should verify the tour dairy of MPHS
(M), MPHA (M), MPHEO every 15 days duly signing in their tour dairy.
3. Should visit all sub-centres once in
15 days and verify the field registers of MPHA (M) related to sanitation,
chlorination etc duly signing in their
tour dairy and field verification of the same to be done and the report to be
submitted to the Medical Officer every
15 days.
4. Ensure that the display of the
statistics of the PHC related to the National Health Programmes for the last 3
years in the Chamber of the Medical Officer.
5. Ensure that PHC Map with sub-centre
locations and the villages are to be displayed in the Medical Officer’s room
and at the Reception area.
(f) JOB CHART OF
MPHEOs:
1. Should guide the MPHS (M) and MPHA
(M) for the measures to be taken to control the water borne and vector borne
diseases and submitting the data for entry in the IDSP portal on real time
basis.
2. Should take measures for control of
Water borne and Vector borne diseases by ensuring proper Sanitation,
Chlorination, Vector control measures and Anti larval operations
3. Ensure that the spray activities
should be completed as per the schedule and super wise the spray activities in
order to control the vector borne diseases.
(g) JOB CHART OF
SENIOR / JUNIOR ASSISTANT:
1. He should maintain Attendance
register as per the Acquaintance register.
2. Should maintain the following
Registers: cash book, Treasury book, Acquaintance register, JSY, JSSK, HDS
funds and other Registers related to funds.
3. He should obtain the signature of
the Medical Officer in all these Registers every 15 days.
4. He should ensure that all the
Delivery patients Should receive their JSY payments through DBT before they are
discharged.
5. Should see that the salaries of all
the employees including the contract employees be paid through online / NEFT by
1st of every month.
(h) JOB CHART OF
MEDICAL OFFICERS:
1. If there is a single Medical Officer
at the PHC he should attend duties of the PHC during the OP hours and take up
the field visits in the afternoon.
2. If 2 Medical Officers are present,
the area of field supervision should be divided between both the Medical
Officers.
3. The I/C Medical Officer should counter
sign in the Attendance register daily at 9:15 AM.
4. Should maintain separate OP
Registers of the Medical Officers with the Name and Qualification of the
Medical Officer on the cover page.
5. All the Medical Officers should
maintain the OP registers properly and fill all the details of the patient and the disease in legible
hand writing.
6. Daily abstract of the OP cases
includes Male, Female, Children, Antenatals, Postnatals, diseases wise to be
written at the bottom of the daily OP in the OP register after the completion
of the OP.
7. The I/C Medical officer should see
that to perform at least not less than 5 deliveries/month in a regular PHCs,
not less than 10 deliveries/month in 24x7 PHCs and not less than 30
deliveries/month including C-sections where ever the Gynaecologist,
Anaesthetist and Theatre facilities are available
8. He should see that CDAC- SCM is
properly done.
9. The Medical Officers should verify
and sign in the Registers that are maintained by the Pharmacist, Staff Nurse,
Lab Technician and Senior Assistant every 15 days.
10.
Should
conduct monthly review meetings with all the field staff.
11.
Should
conduct the HDS meetings regularly at least once in 3 months and maintain the
minutes of the HDS meetings properly and communicate to the Dy. DM&HOs, and
DM&HOs with the resolutions passed and the action taken.
12.
Ensure
that All the IEC related to National Health Programmes should be displayed at
Reception area along with the PHC map with sub-centres and villages.
13.
Ensure
that the display of Employees charter including Call/Shift duties, List of
services, Essential medicines list, List of Laboratory Tests and complaint /
suggestion box to be at the Reception area.
14.
Ensure
that the salaries of all the employees including the contract employees should
be paid through online by 1st of every month.
III. Roles and Responsibilities of Dy. DM&HOs:
Ø
Stipulated timings of working hours: Dy. DM&HOs
shall work from 9:00 AM to 4:00PM. However in emergencies they require to work
for 24 hours.
Ø
Dy. DM&HOs should stay at the headquarters.
Ø
Dy. DM&HOs will prepare advance tour programme
for the month with the list of Sub-Centres / PHCs with date and time to be
submitted to the DM&HO and the District Collector in the last week of the
succeeding month.
Ø
Dy. DM&HOs shall tour a minimum of 20 days per
month.
Ø
Dy. DM&HOs shall install GPS Chip in vehicles.
Bills should not be honoured without chip by the O/o DPMU from September 2015
onwards.
Ø
Since Dy. DM&HOs are the administrative posts,
they are not entitled for any private practice and anything done contrary to
this is punishable.
Ø
Capacity building of ANMs at sub-centres on basic
diagnostic services like Hb estimation, testing of the blood pressure, urine
test for albumin and sugar, taking the measurements like height and weight for antenatal mothers and MCTS on
tablets by ANMs.
Ø
Keep an eye on ASHAs on referring antenatal and
delivery cases to private hospitals. If so to report immediately.
Ø
Review on institutional deliveries – Govt. Vs
private and LSCS Vs Normal Deliveries – facility wise and submit weekly
reports.
Ø
Supporting care of the antenatal cases and delivery
cases (including inpatients) at the 1st referral hospitals
irrespective of DPH&FW / APVVP establishment, at least one day in a week
when they are at their CHNC office and to review JSY and JSSK issues and zero
dose and complete immunization.
Ø
Review the seasonal conditions and to report for
any abnormal trends.
Ø
Supervise the sanitation and chlorination of water
sources - village / sub-centre wise.
Ø
Criteria of performance indicators for 24x7 PHCs
and CHC facilities: Report every month on the performance whether the targets
are met with and redeploy the resources strictly basing on the performance. To
submit the reports and compliance accordingly every month.
Ø
Maternal and Child health services: Dy.
DMHOs. Shall maintain name wise list of High Risk Pregnancy cases with EDDs and
birth plan at CHNCs and monitor these cases closely.
Ø
Capacity building of ANMs at sub-centres on basic
diagnostic services like Hb estimation, testing of the blood pressure, urine
test for albumin and sugar , taking the measurements like height and weight for antenatal mothers and MCTS on
tablets by ANMs.
Ø
Dy. DM&HOs will have the list of children with
Severe Acute Malnutrition (SAM) and all the high risk pregnancies in his area
and will personally monitor the progress and investigate into the social causes
responsible for the condition in coordination with the PHC MO and the senior
PHN of the CHNO and report it. The prevalence of Malnutrition among the
children and Anaemia among Pregnant women and Adolescent girls of each PHC has
to be calculated and be available in the CHNO.
Ø
Maternal and Infant death reviews: All the
reported maternal and infant deaths will be reviewed by the Dy. DM&HO and
the PHC medical officer along with the CHO (F) immediately after the event. The
report and the analysis of the causes of death along with the preventive
measures shall be submitted to the DMHO. Any social causes identified
prevention measures will be discussed with the community / self help groups.
Ø
Monitoring of all the National Disease control
programme: With the supporting team of supervisory staff, the Dy. DM&HO shall
ensure the control and prevention of vector borne diseases, screening of school
children, case based tracking of Leprosy & TB cases, ensure screening and
counselling for HIV and establish linkages for TB & HIV. The Senior
Treatment Supervisor of RNTCP assigned to the area shall report the number of
TB cases and their follow up every month to the Dy. DM&HO. The Dy. DM&HO
shall ensure that PHC Medical Officers will get the drinking water supplies
tested in all the villages during their outreach visit in the PHC mobile
vehicle. The Para Medical Opthalmic Officer (PMOO), if available in the PHC,
will refer the cataract cases from the field to the CHNC, the Dy. DM&HO
will ensure that the senior PMOO positioned at the CHNO will arrange for the
surgeries required. The IDSP reports from the PHCs and the sub centres shall be
analysed and checked for increasing trends of communicable diseases and
corrective measures taken. The Dy. DM&HO shall guide outbreak
investigation, if it occurs in the area.
Ø
Coordination
Activities: DY. DM&HOs will establish linkage
between the Primary Health care system and the referral hospitals. The Dy.
DM&HOs will work in coordination with the CDPO to address the issues
regarding malnutrition among children. They will coordinate with the Private
Nursing Homes and other Non-Governmental organizations working in health to
report communicable and Non-Communicable diseases in the area. The Private
Nursing Homes shall report their performance in terms of number of Caesarian
Sections, Hysterectomies, Tubectomies, Maternal and Infant deaths in their
facilities. They will attend all the HDS meeting and will also conduct monthly
meeting with the medical officers in the area. The Dy. DM&HO will
coordinate with other allied departments like the rural water supply etc. that
have a role in ensuring the health of the communities.
6. The CH&FW and DPH&FW, A.P. Hyd. is
requested to take necessary action.
(BY
ORDER AND IN THE NAME OF THE GOVERNOR OF ANDHRA PRADESH)
POONAM MALAKONDAIAH
PRINCIPAL SECRETARY TO GOVERNMENT
To
The
Director of Health and Family Welfare, A.P. Hyderabad.
The
Commissioner of Health and Family Welfare, A.P. Hyderabad.
//Forwarded
By Order //
SECTION
OFFICER
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