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Workshop on Quality Services under NRHM for Faculty of Medical Colleges
of Good Performing States
(2nd to 5th February, 2010)
WORKSHOP REPORT
National Institute of Health & Family WelfareBaba Gangnath Marg, Munirka, New Delhi-110 067
Workshop on Quality Services under NRHM for Faculty of Medical Colleges of Good Performing States
(2nd to 5th February, 2010)
Workshop Coordinating Team
Workshop Director : Prof. Deoki Nandan (Director, NIHFW)
Workshop Coordinator : Dr. S. Menon
Workshop Co-coordinator : Dr. Bindoo Sharma/ Dr. Vandana Bhatnagar
National institute of Health & Family WelfareBaba Gangnath Marg, Munirka, New Delhi-110 067
(Ph.: 011-26166441, 26165959, 26107773, 26185696,Fax: 91-11-26101623)
E-Mail: [email protected]
INTRODUCTIONNational Rural Health Mission (NRHM) launched in April, 2005 envisages provision of
affordable, equitable and quality health care to the population of India, especially vulnerable groups. National Rural Health Mission has given the guiding principles and has also listed the deliverables and service guarantees required to be ensured by health care providers/institutions. However this needs to be translated to actual good quality service delivery at various levels of health care delivery system (from village to Tertiary health care institutions).
There has been increasing public concern over the quality of health care in recent years both because of increasing awareness amongst the population and mushrooming of health care institutions particularly in the private sector. The quality of health care can be improved by functional health facilities with skilled personnel providing effective and good quality of services.
Medical Colleges are the intellectual and academic capital of the State. The faculty members of medical colleges would be expected to provide the intellectual input on how to apply any program to their state/region, in the context of the needs of their state / region and also demonstrate how good quality health care services can be provided. They would have to therefore understand the centre’s program, have thorough knowledge about the health problems and available infrastructure for health services in their states such that they can adapt the programs for effective implementation through the existing infrastructure to meet the health needs of the population of the state.
Important role of medical college is pre-service teaching and training. The faculty members of medical colleges would have to use not only the textbooks but also ensure that their students both Under Graduates and Post Graduates do have the knowledge and the skills required for provision of good quality heath care services and implementing the program for the state’s needs. Many of the students are likely to work in the private sector in the current situation. This knowledge and skills would therefore help these future doctors to participate in public health programs even while working in private or other sectors.
Medical Colleges and their hospitals in addition to having highly academic faculty also have a large case load which is a major advantage for providing skill up gradation training and enabling the trainees not only to acquire the skills but also learn to diagnose and treat complications. Thus Medical Colleges have a major role to play in knowledge and skill up gradation during in-service training for various service providers. In this their roles may be:
Training of district and below district level trainers Training of MO of PHC/CHC (if necessary). Training for specialised skills (as Lap. Sterilisation, MTP, Minilap, NSV etc.)
‘Workshop on Quality Services under NRHM for Faculty of Medical Colleges of good performing States’ was conducted from 2nd to 5th Feb.2010 in NIHFW, Munirka, New Delhi.
1
Category of Participants
The participants of the workshop were faculty from departments of Obstetrics & Gynaecology, Paediatrics and PSM of medical colleges few trainees from SIHFWs, HFWTCs and SHSRC.
General Objective
To orient the faculty members of medical colleges about the provision of good quality health care services under NRHM so as to enable them to incorporate aspects of quality appropriately in all their teaching and training activities and collaborate with state/district officials for improving services at primary and secondary levels of health care.
Specific Objectives:
At the end of the workshop the participants are able to:
Discuss the key strategies and interventions under NRHM Explain the parameters for accreditation of hospitals Describe the critical issues relevant to quality of Health and Family Welfare services Evolve a mechanism to incorporate key quality aspects while teaching various components
of health care services Orient about quality assurance cells at state and district levels
Workshop Contents:
Overview of NRHM Accreditation of hospitals Role of Medical Colleges in quality services Critical issues relevant to Quality of Health and F.W. Services Infection Control and Biomedical waste management Integration and convergence of Health & Family Welfare Services at different levels of
health care delivery system International Classification of Disease-X Quality Health and F.W services under NRHM
Duration : 4 days (2nd to 5th February, 2010)
Number of Participants : 37 (Annexure-I)
Methodology
Lecture Discussion Group Work Participants Presentation Brain Storming
Evaluation: The workshop was evaluated based on participant’s feedback on structured Performa.
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Salient Features of the Workshop The participants represented medical college faculty from deptt. of obstetrics and
gynaecology, PSM and Paediatrics. There were a few trainers from HFWTC/SIHFW and SHRC. The break up is as follows:
States Obst. / Gyane Paed. PSM HFWTC/ SIHFW, SHSRC
Total
Maharashtra 4 4 8 5 21Gujarat 1 2 2 1 6West Bengal 3 3Punjab 2 1 1 4Haryana 1 1Chandigarh 2 2Total 10 9 12 6 37
Nominations were received from Govt. and private medical colleges from six states and the break up is as follows:
States Name & Address of Medical CollegesChandigarh Govt. Medical College & Hospital, Sector-32, Chandigarh-160030Gujarat 1) Medical College, Baroda-390001, Gujarat
2) Pramukh Swami Medical College, Karamsad-388325, District Anand, Gujarat
Haryana Maharaja Agrasen Medical College, Agroha, Hisar-125047, HaryanaPunjab 1) Christian Medical College & Hospital, Ludhiana-141008, Punjab
2) Govt. College Amritsar-143001, PunjabMaharashtra 1) Govt. Medical College, Aurangabad-431001, Maharashtra
2) Indira Gandhi Government Medical College (IGGMC), Nagpur-440012, Maharashtra
3) MGM Medical College, Kamothe, Navi Mumbari, Distt. Raigad-410209, Maharashtra
4) N.K.P. Salve Institute of Medical Sciences & Lata Mangeshkar Hospital, Digdon Hills, Hingna Road, Nagpur-440019, Maharashtra
5) LTM Medical College, Dr. B.A. Road, Sion, Mumbai (Urban Health Centre, Dharavi) Mumbai-400022, Maharashtra
6) KEM Hospital & G.S. Medical College, Mumbai-400012, Maharashtra 7) B.J. Medical College, Pune Station Road, Pune-411001, Maharashtra8) TN Medical College & BYL Nair Hospital, Mumbai-400008,
MaharashtraWest Bengal 1) Calcutta National Medical College (CNMC), 32, Gorachand Road, Park
Circus, Kolkara-700014, West Bengal2) North Bengal Medical College, Sushrut Nagar, Distt. Darjeeling-
734012, West Bengal
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Workshop on Quality Services under NRHM for Faculty of Medical Colleges of Good Performing States(2nd to 5th February, 2010)
Programme Schedule
Tuesday2.2.2010
9.00 AM -9.30 AM 9.30 AM- 10.30 AM 10.30 AM -11.15AM 11.30 AM -1.00 PM 2.00 PM – 4.00 PM* 4.15 PM – 5.30PM
Registration Introduction, Expectations of
Participants.Briefing about the
course(Dr. Bindoo &Dr. Vandana)
Participant’s perception about quality services under NRHM
(Dr. S. Menon)Discussion
Critical issues in quality of Health & F.W.Services
(Dr. Bindoo)Brain Storming
Group workQuality services under
NRHMFacilitators:
(Dr. S. Menon, Dr. Bindoo & (Dr. Vandana)
Overview of NRHM
(Dr. U. Dutta)Lecture Discussion
9.00 AM – 9.30AM 9.30 AM– 11.15 AM 11.30 AM -1.00 PM 2.00 PM -3.30 PM 3.45 PM-5.30 PM
Wednesday3.2.2010
Recap/experience sharing
(Participant)
Inter-sectoral Convergence
(Dr. Prema Ramachandran)Lecture discussion
Role of Medical college in quality of care
(Prof. Deoki Nandan)Discussion
Monitoring and evaluation under
NRHM
(Dr. Rattan Chand)Lecture discussion
Orientation to ICD-X
(Dr. Ashok Kumar)Lecture Discussion
9.00 AM – 09.30 AM 9.30 AM – 11.15 AM 11.30AM -1.00.PM 2.00 PM – 3.30 PM 03.45 PM– 05.30 PM
Thursday4.2.2010
Recap/experience sharing
(Participant)
Quality Issues in family welfare services under NRHM
(Dr. Kiran Ambwani)Discussion
Integrated service delivery
(Dr .K.Kalaivani)Lecture discussion
Infection control andBiomedical waste
management
(Mrs. Renuka Patnaik)
Lecture discussion
Accreditation of hospitals for quality Services
(Prof. J.K. Das)Discussion
Friday5.2.2010
9.00 AM – 9.30 AM 9.30 AM – 10.00 AM 10. 00AM – 11.15 AM 11.30AM – 1.00PM 2.00 PM – 3.30PM
Recap/experience sharing
(Participant)
Brief about National Health Information Collaboration
Dr. Mirambika Mahopatra
Group work (contd)Quality services under
NRHMFacilitators:
(Dr. Menon & Dr. Bindoo)
Group work presentation by Participants
(Dr. K. Kalaivani, Dr. S. Menon, Dr. Bindoo &Dr. Vandana)
Concluding session
Tea time : 11.15 AM to 11.30 AM; 3.30PM to 3.45 PM *4.00 PM to 4.15 PM Lunch : 1.00 – 2.00 PM
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Sessional Objectives:
1. Perception about quality services under NRHM: To list the various views of the participants regarding quality services. To identify the differences in perception of quality services.
2. Critical issues in quality of Health & F.W. services Discuss the critical issues relevant to provision of good quality of maternal & child
health, Family planning and disease control services.
3. Quality services under NRHM: (Group Work):A. Reproductive health Services (Maternal, RTI/STI, contraception, Infertility etc.)
B. Child health services including newborn care. (Preventive and curative Services).
C. Communicable and non-communicable diseases health care services. (Preventive and curative Services)
D. Development of supervisory checklist for quality services during Village Health and Nutrition day.
Terms of Reference (TOR) for Group Work: Enumerate the outdoor as well as inpatient services relevant to group work. List the quality issues relevant to the services. Explain a mechanism for addressing the quality issue. Discuss how Medical colleges can develop linkages or mechanism to improve the service
delivery at all levels of health care delivery (from village level to district levels)
4. Overview of NRHM: Enumerate the key strategies under NRHM. Explain various interventions under NRHM.
5. Inter-sectoral Convergence: Describe the mechanism of inter-sectoral convergence under NRHM. Explain how inter-sectoral convergence improves quality of services.
6. Role of Medical College in quality of care: Explain what is quality of Care. Describe the role of medical college in quality of care.
7. Monitoring and evaluation under NRHM: Explain the mechanism of monitoring and evaluation under NRHM. Discuss importance of NFHS, DLHS data.
8. Orientation to ICD-X:
Explain the rationale of ICD-X. Discuss the importance of ICD-X.
9. Quality issues in family welfare services under NRHM: Explain quality of care for maternal ,child health and Family planning services
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Describe the mechanism of quality assurance for family welfare Services.
10. Integrated service delivery: Describe the mechanism of integrating the services at various levels of Health care delivery
system
11. Infection control and Biomedical waste management: Discuss the Infection prevention and control measures. Explain the standard Precautions. Describe the procedures relevant to biomedical waste management.
12. Accreditation of hospitals for quality Services: Explain the importance of accreditation of hospitals. Describe the parameters/criteria for accreditation of hospitals under NRHM.
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WORKSHOP PROCEEDINGS
Day 1: 2/2/2010
The workshop started with the self introduction by participants and workshop coordinators. The participants were asked to write down their expectations from the workshop. The expectations are listed in Annexure-IV.
Most of participants had the following expectations:1. How to incorporate quality services in the medical college2. Newer interventions under NRHM
Participant’s Perception about Quality Services under NRHMThe session was conducted by Prof. S. Menon, who asked the participants to explain their perception of quality. She explained that for everyone the perception may be different. The participant’s perceptions are given in Annexure-V.
The following issues were highlighted: Quality is quantifiable Perception depends on the interest of the participants. Benchmark standard should be set and once it is reached then a higher standard should be
set.
Highlights
Most of the participants felt that client’s satisfaction is the major parameter of quality. Only 4 participants felt that performance to standards is an important benchmark of
quality
Critical issues in quality of Health & F.W. servicesThis session was taken by Dr. Bindoo by the brainstorming method. All the participants were divided into three groups and were asked to identify critical issues in provision of:
Maternal Health services Child Health Services. Service environment favorable for Good Quality Services.Each group was asked to discuss amongst themselves and present the observations which were discussed amongst all the participants. The presentation (s) is included as Annexure-VI.
There were a few cross cutting issues like:Issues Strategies under NRHM
Accessibility, Affordability & Accreditation Architectural correctionBehaviour of service providers Behaviour change communication Continuity of services Citizens charterDelays and equity Differential strategy
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Group Work Quality Services under NRHM:For group work the participants were divided into 4 groups by the facilitators. Each group consists of representatives from different states and specialties viz maternal health, child health, community medicine and from training centre. The presentations made by participants are given in Annexure-VIII.
Overview of NRHMDuring the session on Overview of NRHM Dr. U. Datta talked about the vision of NRHM. He enumerated the goals of NRHM which includes providing universal access to equitable, affordable and quality health care services, responsive to the needs of the people. He explained the expected outcomes of NRHM at the community level. He talked of how to improve the Public Health Delivery System. He explained how decentralization and convergence is being implemented in the country.
He explained about the architectural corrections and the funding under NRHM. He discussed about the new strategies under NRHM.
Highlights
Improving public health delivery system, convergence, decentralization and architectural corrections as per IPHS are some of the interventions under NRHM.
For improving public health delivery system capacity building of PRIs, PMSUs and health professionals is one of the steps.
Day II: 3/2/2010
Experience Sharing (Annexure-VII)Dr. Arun Humne
He shared the experience related to evaluation of mother NGOs and field NGOs under NRHM, funded by State Health Systems Resource Centre, Pune. It was suggested that this could be reproduced by others so that the medical college will be able to use their manpower for reaching out to the public within the system.
Dr. R.R. Shinde spoke about
Establishing Integrated Disease Surveillance Programme (IDSP) in the hospital involving clinical departments coordinated by PSM department.
IDSP is one of the flagship program of Government of India, promoting quality data management in disease surveillance. The focus is on ensuring uniformity, standardization, reliability, accuracy, consistency & diligency in disease data collection, compilation, analysis and public health applications.
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The faculty of PSM and resident doctors conduct a preventive OPD in KEM Hospital daily. All new patients & patients on chronic management are first referred to preventive OPD. The preventive OPD undertakes screening, counseling, health education, treatment of uncomplicated cases.
The Medicine & Paediatrics OPD is on the same floor and hence, where essential, immediate escorted referral of cases is possible.
This has facilitated cooperation & active participation of clinical faculty in IDSP. At institutional level, PSM department has assertively introduced role of PSM faculty as “Doctors of Health” and role of clinical specialists as “Doctors of Disease”. In public health terms, clinicians are now referred as specialists of secondary & tertiary prevention.
Inter-sectoral Convergence:In this session Dr. Prema Ramachandran explained that there quantifiable determinants & ingredients of quality which include infrastructure/manpower, processes for diagnosis & treatment, safety & timeliness of interventions outcome and cost of care. She explained the pre-requisites of good quality of services.
She explained that convergence will result in provision of quality services by ensuring better coverage, content and timeliness. She further explained how synergy between AWW, ASHA & ANM can help to ensure better safe abortion services, better Antenatal care, increased institutional delivery and management of malnutrition. She talked of how the convergence between vertical health programmes and RCH can help to achieve integrated services. She described the Antenatal card developed by ICDS which was distributed to all the participants of the workshop. She explained how to standardize the weighing machine for accurate measurement of the change in weight and for estimation of BMI. She cautioned that most of the ‘weight for height cards’ are developed by the western world. She ended by informing the participants about the advantage of estimating BMI for cards identification of both under & over nutrition.
Highlights
Intra- sectoral convergences between different health sector programmes Inter-sectoral coordination between health, nutrition, education, water supply sanitation and other related sectors has synergistic effect and improves performance in all the sectors. It is essential that efforts are made to ensure that coordination occurs at all levels especially during implementation at or below district level
integrate the activities related to procurement, logistics of supply, training, IEC, HMIS under different vertical programmes;
Role of Medical College in Quality of Care:In the session the Director explained to look into the need of the citizens of the country and work for their benefit. He said that knowledge, analysis, planning etc. should be for the people’s benefit and not just of academic importance. He also said that some states like Bihar, UP, MP and West Bengal need to have more Medical Colleges and the medical colleges should realize their responsibilities towards the rural India.
9
He stated that Medical Colleges and the Medical College Hospitals given their vast and diverse case load and the experienced expert faculty should be the best skill up - gradation training centres. The Medical Colleges can ensure that their undergraduate and postgraduate students as well as participants in training courses understand the rationale, components as well as strategies of all the programs ,also ensure that they do have the knowledge and the skills required for implementing the program for the state’s needs.
The Medical College Hospitals should act as Apex Training Centres by practicing the program components in National Training Strategy for In-service Training under National Rural Health Mission and their routine service delivery, thereby, enabling the post graduate and under graduate students to practice & achieve all the skills required pre-service.
He added that there should be paradigm shift in curriculum and issues like Mainstreaming AYUSH, Telemedicine/ICT, Tobacco Control, Patients Rights in health, Standard treatment guidelines, ICD -10 Classification, Revitalizing Primary Health Care and Stress Management should be included.
Some of the deficient areas like Counseling skills, Quality issues, Elementary Nursing practices & Geriatric Care should be strengthened.
He concluded by giving an example how the first years may be posted in the wards, listen to conversation of patients and relatives to learn social behaviour/concerns.
Highlights
Medical Colleges should not be viewed in isolation The Medical Colleges can ensure that their undergraduate and postgraduate students as
well as participants in training courses understand the rationale, components as well as strategies of all the programs ,also ensure that they do have the knowledge and the skills required for implementing the program for the state’s needs.
Integrated/ multi-disciplinary teaching and enabling environment
Monitoring and Evaluation under NRHMDr. Rattan Chand talked about Monitoring and Evaluation. He described about DLHS and it is concurrent evaluation of NRHM through independent agencies like IIPS.
District wise indicators on CBR, CDR, IMR MMR for a group of districts
He informed that Indicators to be covered in Annual Health Surveys (AHS) finalized in meeting of the Steering Committee held on 9th September, 2009. A Technical Advisory Group (TAG) has been constituted under the chairmanship of Dr. N.S. Sastry, Ex-DG NSSO to finalize survey instruments. The Annual Health Survey is expected to be launched by March 2010 and results expected by early 2011. Regarding HMIS he stated that: Formats finalized in consultation with program divisions Separate facility level formats Information flow has changed from paper to electronic form
10
HMIS portal has been launched and is functional.He cautioned about the need to validate data received from different sources like HMIS, surveys etc. He said Expert Group needed to guide triangulation activities has been established and data triangulation work on MCH and FP is under progress.
Highlights
Indicators to be covered in AHS finalized in meeting of the Steering Committee held on 9th September, 2009
Survey expected to be launched by March 2010 and results expected by early 2011 Expert Group to guide triangulation activities established Data triangulation work on MCH and FP under progress.
Orientation to ICD-10This session was conducted by Dr. Ashok Kumar. He explained the need of International classification of Disease-10 (ICD-10) and enumerated some of the initiatives taken in the country to promote the use of ICD-10. He informed that Central Bureau of Health Intelligence (CBHI) has prepared and released the Module & Workshop-Orientation Training on ICD-10 for distribution to the trainees as reference and self learning module. This module has been updated and reprinted in 2008. Certain initiatives taken by CHBI towards manpower development are: Request to Director General of (i) Armed Forces Medical Services, (ii) Railways Health
Services and (iii) ESI, for appropriately ensuring the use of the ICD-10 in their respective medical and health care institutions and develop the trained manpower.
In 2008, Based on the need, the orientation on International Classification of Functioning Disability & Health (ICF) in India was integrated with the orientation training on ICD-10 as devised by the experts during National Workshops, 18th November & o4 -05 th December, 2008 and updated to the “Orientation Training Course on FIC (ICD-10 &ICF)”, one week, separately, for Master Trainers and Non-Medical Functionaries.
CBHI has already institutionalized orientation training on Functionaries of IRDA and Health Insurance Companies in India-FIC (ICD-10 & ICF) through its various training centers in different regions of the country
Highlights
ICD-10 coding system be implemented throughout the country for comparison at both, national and international levels and the use of ICD-10 be concurrently monitored by hospital administration for timely corrective measures at various levels, including meeting the ICD-10 trained manpower needs
All the Government Allopathic Medical Colleges and Medical Council of India have been requested and being pursued to ensure appropriate teaching and skill on use of ICD-10 as part of the under- graduate and post- graduate degree curricula.
Day III: 4/2/2010
Experience Sharing
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Dr. Dinesh Bhanderi shared his experience on “Evaluation of the government health care services provided to women in reproductive age and children under three years age in Anand district. The observations included that in small & remote villages, the distribution of ‘Mamta card’ is not satisfactory, visits by FHW & supervisory staff were also very less than desired and Mamta card was not used adequately for educating the women regarding nutrition, warning signs, self-care & newborn care. The recommendations included that IEC activities to create awareness regarding various government programmes and schemes need to be strengthened so as to maximize their utilization by the beneficiaries and Mamta card should be extensively used for education & counseling of pregnant women & mothers.
Quality Issues in Family Welfare Services under NRHMThe session was conducted by Dr. Kiran Ambwani who talked about the various dimensions of quality services and the steps taken to improve RCH services. She elaborated on quality assurance committee and quality circles. She informed how quality council of India is supporting GOI in adapting quality standards at different levels and conducting awareness seminars. She shared experiences of different state in improving quality. she summarized by reminding that quality requires setting and achieving standards of service availability to all and that GOI support is available for states to take initiatives.
Highlights
Dimensions of quality include perceptions of service provider, client (user) and the service environment
Focus on Quality is essential for achieving National Health Goals & ensuring sustainability and credibility of Public Health Systems;
Support of GOI available for States to take initiatives.
Integrated Service DeliveryThe session was conducted by Prof. K. Kalaivani who described the current practices of service provision with their disadvantages e.g. Immunisation and MCH services are provided on separate days. This implies that the women needs to come twice for seeking services i.e. for immunisation, contraception etc., which has direct implications on their time lost for work and wages. She informed that the proposed strategy in NRHM to ensure provision of services at periphery in all villages which is the village health and nutrition day. She enumerated the services to be provided at the AWC during the VHND.
Highlights
The work schedule is not displayed in the sub-centre or PHCs or in the community, people remain unaware of the services being provided and also the availability MPHW (M&F) in the village on a particular day.
There is lack of clarity in job responsibility of MPHW(M&F), which clearly leads to non performance of work as well as low quality of services provided.
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Infection Control & Biomedical Waste ManagementThe session was conducted by Mrs. Renuka Patnaik who informed that infection prevention means prevention of occurrence of infection and minimization of risk of transmitted infection while providing services for contraception, childbirth, newborn care, post natal care, etc. She pointed out that all objects coming in contact with patients should be considered potentially contaminated. She explained the difference between disinfection, decontamination, cleaning and asepsis. She gave examples from her monitoring visits.
Highlights
Minimization of risks of transmitting infection while providing services for contraception, childbirth, newborn care, post-natal care, immunization, post-abortion care and management of RTIs/STIs.
To address these issues, an Infection Management and Environment Plan (IMEP) has been formulated by the MOH&FW, GOI with the aid of DFID India
Operational Guidelines designed for easy utilization by healthcare workers at CHCs, FRUs, PHCs and SCs with simple instructions and pictorial presentation of infection control and waste management procedures
Accreditation of Hospitals for Quality ServicesProf. J.K. Das informed that Accreditation is now a world trend in health care and that accreditation benefits are patients, community and hospital as well as employees. Internationally the best-known focused accreditation programmes are WHO/UNICEF’s Baby Friendly and Mother Friendly Hospital initiatives. Accreditation or other EQA programmes are most likely to successfully improve quality if they are voluntary and exist in conjunction with enforced governmental licensure that assures minimum standards.
The process of accreditation is includes initial application including self assessment as per the laid down standards, screening of the application followed by assessment survey and accreditation committee recommendations.
Highlights
Accreditation process encourages those that are doing the best work, and stimulates those of inferior standards to do better.
The most effective means of providing long-term support for an accreditation / EQA programme is indirect, by establishing financial incentives for organizations to participate.
Day IV: 5/2/2010
Experience Sharing1. Dr. Gautam Mukhapadhyay talked about the role of injection magsulf in the treatment of
ecclampsia. He said that gradual persuasion and use of low dose magsulf in the periphery has resulted in decreasing the morbidity of ecclampsia.
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2. Dr. Seema Ananjaya shared her experience regarding provision of integrated teaching in the under graduate in the second year MBBS students. She explained how integration is being done between the departments of PSM, paediatrics, obstetric. She said that the study will be completed in April 2010 in order to evaluate the outcome of integrated teaching in the community. The topics covered include breastfeeding, PEM and malnutrition.
3. Dr. A.P. Kulkarni spoke about his experience in finalization of the PIP for Maharashtra. He informed the group during his career at the Medical College there were lot of issues about which he was not aware. After joining SHRC, Pune he has realized the spectrum of issues which need to be addressed by Medical College faculty as well.
The participants gave suggestions for involvement of medical college faculty in NRHM (Annexure-IX)
Dr. Mirambika, From NIHFW
She demonstrated the portal for National Health Information Collaboration (NHIC) to the participants. The participants felt that there should be strict rules for including articles at the NHIC. Some of the participants visited the computer centre of the institute for practicing the use of this portal.
Presentation on Group Work
All the four groups presented their group work to Prof. Menon. All the group’s presentations were appreciated. However, the following issues were raised:
Presentation on disease control addressed the issues of quality services in the tertiary centres predominantly.
The checklist in the village health and nutrition day did not include any experience of the group.
Concluding Session The valedictory session was chaired by Dr. M. Bhattacharya, Dean of Studies who asked the participants to explain what were the additions in their knowledge following the workshop. Dr. Sushma Malik (Pead) informed that there were so many interventions under NRHM about which she was not aware and she was happy to learn about them. Similarly Dr. Bhosale (Obst./Gynae) felt the experience sharing was another strong feature of the workshop. Suggestions to involve medical colleges in NRHM were taken from the participants and is included as Annexure-IX.
Dr. Dinesh Bhanderi gave a brief on the sessional evaluation which is included as Annexure-X (A). He clarified that most of the sessions were satisfactory but suggestions were given for improvement in most of the sessions which are included.
The workshop evaluation was done by Dr. Shinde and the workshop evaluation is included as Annexure-X (B) in which suggestion for improvement have been included as well. The participants found the workshop to be democratic, informative and helpful.
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Workshop on Quality Services under NRHM for Faculty of Medical Colleges of Good Performing States (2nd to 5th February, 2010)
List of Resource PersonsS. No.
Name Designation Ph/Fax No. E-Mail ID
External:1. Dr. Ashok Kumar Dy. Director General &
Director, Central Bureau of Health Intelligence Dt. General of Health Services, Room No. 401 & 404-A Wing, Nirman Bhawan, New Delhi-110 011
(O) 011-23062695 23061529(F) 011-23063175(M) 9868891147
2. Dr. Kiran Ambwani DC (F.P.)Room No. 311-D, MOHFW,Nirman Bhawan, New Delhi
(O) 011-23062485Ext/ 2789/ 464(F) 23062485
3. Dr. Rattan Chand CD (Statistics)/ CD (M&E),Room No. 243-A, Nirman Bhawan, Maulana Azad Marg, New Delhi-110 011
(O) 011-23062699 [email protected]
4. Dr. Prema Ramachandran
Director, NFI & Former Advisor (Health) Planning CommissionNutrition Foundation of IndiaC-13, Qutab Institutional AreaNew Delhi - 110 016, India
(M) 9891485605 [email protected]
Internal :1. Prof. Deoki Nandan Director, NIHFW, New
Delhi011-26165959Ext – 301, 302011-26101623 (Fax)
[email protected] [email protected] [email protected]
2. Prof. K. Kalaivani HOD, RBM and Nodal Officer, NRHM/RCH , NIHFW
011-26165959Ext – 330, 333011-26160158(Fax)
[email protected] [email protected]
3. Dr. S. Menon Professor ,Deptt. of RBM, Asst. Nodal Officer, NRHM/RCH, NIHFW.
011-26165959Ext – 125, 387011-26160158 (Fax)
[email protected] [email protected]
4. Prof. J.K. Das HOD, Epidemiology, NIHFW, New Delhi
011-26165959Ext – 307
5. Prof. U. Dutta HOD E&T, NIHFW, New Delhi
011-2616595Ext-314
6. Dr. Bindoo Sharma Sr. Consultant – RCH, NIHFW
011-26165959Ext – 376
7. Mrs. Renuka Patnaik Consultant, RCH, NIHFW 011-26165959Ext – 367
8. Dr. Vandana Bhatnagar
Consultant - RCH, NIHFW
011-26165959Ext – 238
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Annexure-I
Workshop on Quality Services under NRHM for Faculty of Medical Colleges of Good Performing States (2nd to 5th February, 2010)
List of Participants
S. No.
Name & Designation Department Office Address Phone Nos. / Fax E-mail Address
Chandigarh 1. Dr. Kana Ram Jat
(M.D. Pediatric)Asst. Professor
Pediatrics Govt. Medical College & Hospital, Sect.32, Chandigarh-160030
M: 9646121525Res : 9872308656
[email protected]@gmail.com
2. Dr. Geetanjali Jindal (M.D. Pediatric) Asst. Professor
Pediatrics Govt. Medical College & Hospital, Sect.32, Chandigarh-160030
M: 9646121595Res : 2624222
[email protected][email protected].
in
Gujarat3. Dr. Omprakash Shukla
(M.D. Pediatric) Asso. Professor
Pediatrics Medical College, Baroda-390001, Gujarat
Off : 0265-2422883 M : 9426370860
4. Dr. Nitin Raithatha(M.D. Gynae)Asso. Professor
Obst. & Gynae.
Pramukh Swami Medical College, Karamsad-388325, District Anand, Gujarat
Off : 02692-222130 M : 09825197277
[email protected][email protected]
5. Dr. Dipen Patel(M.D. Pediatrics)Asst. Professor
Pediatrics Pramukh Swami Medical College, Karamsad-388325, District Anand, Gujarat
Off : 02692-222130 Res : 02764-265269
6. Dr. Dinesh Bhanderi(M.D. Community Medicine)Asso. Professor
PSM Pramukh Swami Medical College, Karamsad-388325, District Anand, Gujarat
Off : 02692-222130 Res : 02692-231721
[email protected]@gmail.com
7. Dr. Navnit Padhiyar (M.D.)Asst. Professor
PSM Medical College, Baroda-390001, Gujarat
Off : 02651-2427545 Res: 9228186060M: 9427226707
8. Dr. Kiritkumar Ratilal Shah(MBBS)M.O. (Epidemiologist)
Epidemiology
SIHFW, S.G. Highway, Sola Civil Hospital, Ahmedabad-380060, Gujarat
Off : 079-27662811 Res : 079-26440809Fax: 079-27665964
Haryana9. Dr. Seema Choudhary
(M.D., Community Medicine)Asso. ProfessorCommunity Medicine
PSM Maharaja Agrasen Medical College, Agroha, Hisar-125047, Haryana
Off : 01669-281193 Ext.: 264Off : 01669-281176 M : 9896247710
16
S. No.
Name & Designation Department Office Address Phone Nos. / Fax E-mail Address
Punjab10. Dr. Geetika Dheer
(M.D. Pediatrics)Asst. Professor
Pediatrics Christian Medical College & Hospital, Ludhiana-141008, Punjab
Off : 0161-2229010M : 9872206670
[email protected]@gmail.com
11. Dr. Ashok Salwan(M.D., MBBS, DGO)Asst. Professor
Obst. & Gynae.
Govt. Medical College Amritsar-143001, Punjab
Res: 0183-3299760M: 9915068181
12. Dr. Pratibha Dabas(M.D., MBBS)Asst. ProfessorCommunity Medicine
PSM Christian Medical College & Hospital, Ludhiana-141008, Punjab
Off: 0161-6450829M: 9780243695
13. Dr. Moneet Walia(M.D., MBBS)Asst. Professor
Obst. & Gynae.
Christian Medical College & Hospital, Ludhiana-141008, Punjab
Off: 0161-22290101M: 9876020475
Maharashtra14. Dr. Mohan K. Doibale
(M.D. PSM)Asso. Professor
PSM Govt. Medical College, Aurangabad-431001, Maharashtra
Off : 0240-2402424 Res : 0240-2354393Fax : 0240-2402418M: 09422203393
15. Dr. Anita Banerjee (M.D. Pediatrics)Lecturer
Pediatrics Indira Gandhi Government Medical College (IGGMC), Nagpur-440012, Maharashtra
M: 9881010321 [email protected]
16. Dr. Seema Anjenaya Professor & Head
PSM MGM Medical College, Kamothe, Navi Mumbari, Distt. Raigad-410209, Maharashtra
Off : 022-2742 7997Res : 0251-2202170M: 9821661558
17. Dr. Madhukar S. Pawar(MBBS, DPH, MD) Principal
PSM (HFWTC)
Health & Family welfare Training Centre, Nashik, Civil Hospital Campus, Nasik-422001, Mumbai
Off : 0253-2311201Res : 0253-2575108Fax: 0253-2311201
18. Dr. Sudhakar B. Kokane (MBBS, DPH)Principal
HFWTC, Pune
Health & Family welfare Training Centre, Aundh Campus, Pune-411027, Mumbai
Off : 020-27281255Res : 020-25453171Fax: 020-27281255M: 09422021581, 09867218951
[email protected]@yahoo.co.in
19. Dr. Vijay KamaleProfessor
Pediatrics MGM Medical College, Kamothe, Navi Mumbari, Distt. Raigad-410209, Maharashtra
Off : 022-27423404Res : 022-64217771M: 9224475712
20. Dr. Pankaj Patil (M.D.)
Obst. & Gynae.
MGM Medical College, Kamothe,
Off : 022-27427997
[email protected]@gmail.com
17
S. No.
Name & Designation Department Office Address Phone Nos. / Fax E-mail Address
Asst. Professor Navi Mumbari, Distt. Raigad-410209, Maharashtra
M: 9222177561
21. Dr. Anjali Edbor (M.D. Pediatrics)Asso. Professor
Pediatrics N.K.P. Salve Institute of Medical Sciences & Lata Mangeshkar Hospital, Digdon Hills, Hingna Road, Nagpur-440019, Maharashtra
Off : 07104-236201M: 09822470808
[email protected]@gmail.com
22. Dr. Pallavi S. Shelke(M.D., DPH, DNB, MPS)Asso. Professor
PSM Lokmanya Tilak Municipal Medical College, Deptt. of PSM, Dr. B.A. Road, Sion, Mumbai (Urban Health Centre, Dharavi) Mumbai-400022, Maharashtra
Off : 022-24038983, 24063123M : 9867003734Fax: 022-24038983
[email protected]@gmail.com
23. Dr. Ratnendra Ramesh Shinde (M.D.)Prof.& Head
PSM G.S. Medical College, Deptt. of PSM, 3rd Floor, Library Bldg. Parel, Mumbai- 400012, Maharashtra
Off : 022-24107074M : 9820097514Fax: 022-24166006
[email protected]@yahoo.com
24. Dr. Rajan N. Kulkarni (MBBS, DPH, M.D.)Asso. Professor
PSM G.S. Medical College, Deptt. of PSM, Parel, Mumbai- 400012, Maharashtra
Off : 022-24107484M : 9819960961Fax: 022-24142503
25. Dr. Payal Laad (MBBS, M.D.)Asst. Professor
PSM Lokmanya Tilak Municipal Medical College, Deptt. of PSM, Dr. B.A. Road, Sion, Mumbai (Urban Health Centre, Dharavi) Mumbai-400022, Maharashtra
Off : 022-24038983, 24063123M : 9699740416Fax: 022-24038983
[email protected]@yahoo.com
26. Dr. Ramesh A. Bhosale (M.D.)Professor
Obst. & Gynae.
B.J. Medical College, Pune Station Road, Pune-411001, Maharashtra
Off : 020-26128000Res : 020-26133367Fax: 020-26126868M: 9823037565
[email protected]@yahoo.co
m
27. Dr. Shailesh Deshpande(M.D. PSM)Sr. Consultant (Research & Documentations)
PSM State Health Systems Resource Centre, 1st Floor, Arogyabhavan, Parivartan Building, Alandi Road, Yerawada, Pune- 411036, Maharashtra
Off : 020-26615505Res : 020-25386821Fax: 020-26615505M: 9890394334
[email protected]@gmail.com
28. Dr. Deepak Phalgune(M.D. PSM, Ph.D)Sr. Consultant
RCH, CTI-PSM
KEM Hospital & Research Centre, Sardar Moodliar Road, Rasta Peth, Pune-411011, Maharashtra
Off : 020-26135091Res : 020-25440197Fax: 020-26125603M: 9850434220
[email protected]@gmail.com
18
S. No.
Name & Designation Department Office Address Phone Nos. / Fax E-mail Address
29. Dr. A.P. Kulkarni(BSc, MBBS, DPH, MD, Ph.D)Sr. Consultant
Public health SHSRC, Pune-411006
State Health Systems Resource Centre, 1st Floor, Arogyabhavan, Parivartan Building, Alandi Road, Yerawada, Pune- 411036, Maharashtra
Off : 020-26612010Fax: 020-26610180M: 9422701650
[email protected], [email protected]
30. Dr. Jitendra K. Deshmukh (M.D., DGO, DFP, DICOG, FCTS, DNB) Asso. Professor
Obst. & Gynae.
Govt. Medical College, Nagpur-440010, Maharashtra
Res: 0712-2545296Fax: 0712-2750145M: 9822200820 9422164768
[email protected]@rediffmail.com
31. Dr. Chinmay Pataki (M.D. Obst. & Gynae.)Asst. Professor
Obst. & Gynae.
Lokmanya Tilak Municipal Medical College, Deptt. of PSM, Dr. B.A. Road, Sion, Mumbai (Urban Health Centre, Dharavi) Mumbai-400022, Maharashtra
Off: 0222-4063152M: 9769134005
32. Dr. (Mrs) Sushma Malik (M.D. Pediatrics)Prof. Incharge NICU
Pediatrics Deptt. of Pediatrics, 1st Floor, College Building, TN Medical College & BYL Nair Hospital, Mumbai-400008, Maharashtra
Off : 022-23027000 Extn. 7139Fax: 022-23072663M: 9819065322
33. Dr. Arun HumneM.D.( PSM) D.P.H.
PSM Govt. Medical College Nagpur, Near Hanuman Nagar, Nagpur-440003, Maharashtra
Off : 0712-2701369Res : 0712-2701711Fax: 0712-2701369M: 9422102844 9921251441
34. Dr. Prakash Adhav(PGD, M.D., DIH)Professor & HOD
PSM B.J. Medical College, Pune Station Road, Pune-411001, Maharashtra
Off : 020-25897563M: 9371010297
[email protected]@gmail.com
West Bengal35. Dr. Bidyut Kumar Basu
(MBBS, M.D.)Professor
Obst. & Gynae.
Calcutta National Medical College (CNMC), 32, Gorachand Road, Park Circus, Kolkara-700014, West Bengal
Off : 0332-2897122, 2897123Res: 0332-3374098M: 09433847695
[email protected]@rediffmail.co
36. Dr. Gautam Mukhopadhyay(M.D. DGO) DNB Asso. Professor
Obst. & Gynae.
N.B. Medical College, P.O Sushruta Nagar-734012, Siliguri, Dist. Darjeeling, West Bengal
Off: 0353-2585478M: 09434377088 09434377088
[email protected][email protected]
37. Dr. (Mrs.) Sohini Bhattacharya(M.D.)
Obst. & Gynae.
N.B. Medical College, P.O Sushruta Nagar-734012, Siliguri, Dist. Darjeeling, W.B.
Off: 0353-2585478M: 9832072309
[email protected]@yaho
o.co.in
19
Annexure-II
CD Contents
1. Presentations
2. Group photograph
3. Guidelines
NFHS-3 IPHS SC, PHC, CHC (Downloaded October 2007) Rogi Kalyan Samiti Standards for Male & Female sterilization Training of Trainers on Capacity Building of MC Faculty in RCH-
IINRHM Strategies Four Years of NRHM 2005-2009 Adolescent Health and Development (AHD) NPIP RCH Phase II[1] District Health Action (Downloaded October 2007) Manual for Family Planning Insurance Scheme (January 2008) FRU Guidelines 2004 Guidelines for AWWs, ASHAs, ANMs, PRIs - VHND Guidelines for Operationalizing a Primary Health Centre for Providing 24-
Hour Delivery and Newborn Care Under RCH-II Guidelines for Setting up Blood Storage at FRU (October 2007) IUCD Reference Manual for MO NRHM-Frame Work for Implementation NGO guidelines NRHM Mission Document (October 2007) NRHM Evaluation Report Quality Assurance Manual for Sterilization services SOP Book (FP) National Training Strategy IMEP guidelines
20
Annexure-III
Documents Distributed
1. Reference Manual for Minilap Tubectomy
2. Monthly Village Health Nutrition Day (Guidelines for
AWWs/ASHAs/ANMs/PRIs
3. Capacity Building of Medical College Faculty in RCH-II/NRHM (Background
Document Vol. I National Rural Health Mission)
4. Capacity Building of Medical College Faculty in RCH-II/NRHM (Background
Document Vol. II Reproductive and Child Health)
5. Capacity Building of Medical College Faculty in RCH-II/NRHM (Background
Document Vol. III National Health Programme)
6. Manual For Family Planning Insurance Scheme
21
Annexure-IV
Expectation of Participants from the Course
1. Skills & promotion2. Laparoscopy, Sterilization, NSV Training3. We will get guidelines & teachings to improve teaching to our students in rural areas. To
know role of medical colleges.4. Gain knowledge and skills of the NRHM/RCH for the activities that we perform to improve
the quality of training under RCH-II that in turn will improve services at primary & secondary levels of health care.
5. To improve health care delivery system and it should reach at bottom level with quality.6. I want to go back with a direction in the form of an action plan with a continued link with
the NIHFW, have a life long relationship with NIHFW. 7. We will get guidelines and teachings from here to teach our students (budding doctors) to
serve better in rural areas. 8. I expect that the workshop will deal with the NRHM goal and activities in some detail &
subsequently focus on how the quality of services in the health sector can be improved.9. To understand medical teachers role in teaching NRHM to medical students and patients
care in teaching hospital.10. To brainstorm on causes of failure and ways to arrange for all those things needed to
provide ideal care of education to patients/students.11. What will be the role of our medical college in adapting NRHM12. Enabling to improve the quality of teaching and health- management at medical college &
state level and also general guidelines. 13. I expect to know in depth different facts of NRHM and acquire skill to deliver quality
services under NRHM and also to train my colleagues and junior in this aspect. 14. Adequate knowledge regarding how to improve quality services at their medical colleges
respectively.15. How best the medical college faculty be used for effective implementation of NRHM/RCH?16. To orient ourselves (medical faculty) about ensuring quality health services to the
community & percolate it to our students. 17. To gain information regarding newer policies of govt. for NRHM & RCH programme and
implementation of these programmes through private medical college.18. - To learn feasible, practical affordable interventions to achieve quality health services to
all stake holders. - How to introduce in medical education curriculum teach & evaluation?
19. Developing skills to practice and teach (guide) quality care while delivering health care for families.
20. The course should give practical insights in developing “checklists” for monitoring & “indicators” for evaluation of quality of services under NRHM/RCH & generate mechanism for linking medical colleges’ expertise with state health services.
21. To know the key strategies of NRHM, critical quality health issues and mechanism to incorporate quality in health care services.
22
22. To enhance the knowledge and skill on NRHM, so as to improve the health care delivery system in rural health.
23. To provide quality services to patients at minimum cost so that we are able to increase our IPD and patients goes fully satisfied and sends other patients in multiplication.
24. We will be trained in quality services so that we will train lower cadres (DHD, ADHO, Medical officer, paramedical etc.) appropriately.
25. How to execute services under NRHM in proper way at all levels of health system.26. My main expectation of this workshop/course is to enable to know and give better services
in health both at hospital and community level. 27. As an incharge of rural health centre in a tribal village under medical college, I expect to
learn innovative ways of launching existing health services under NRHM to deliver the quality.
28. Knowing ways and means of improvement of quality of health care.29. How we can further improve quality of services given at government hospital30. To get practicable, applicable, affordable and cost effective and definitely suitable
knowledge for 75% of Indian population for improvement of economic and social upliftment there by helping all of us.
31. Improvement of the quality of obstetric care. To reduce the maternal mortality and morbidity keeping in mind the limited resources available at the medical institute.
32. Quality indicators of NRHM/RCH33. To acquire in-depth understanding of NRHM and ways of quality induction in it.
U̵ To help me in improving quality of health care at peripheral level. 34. Funding for logistic & to prepare more human resources (capacity building) to
maintain/establish quality services under NRHM.
23
Annexure-V
Participant’s Perception about Quality Services under NRHM by Group-I are as follows:
1. Quality is all good constitutions of a thing which can bring good results.2. Quality is giving best out of available resources3. Satisfaction and something which should be achieved the community.4. A patient when comes to doctors at any level of care is 100% sure that it is the best which is
given to him and the same is true regarding the doctor. Both are 100% sure and confident in the treatment.
5. Quality improvement remains a constant process.6. Quality is maximum output with minimum input.7. Quality in health care is to provide standard of care to all equally as we have proposed to
give.8. Quality is cream, essence or best part of something. 9. Quality is achieving the objective with patient/people satisfaction and convenience and
needs being the top most priority, services being updated with time.10. The final result of anything and everything in a practicable suitable manner presented
beautifully and easily understandable and presentable.11. Quality is “How much percentage of expected out of it”.12. Quality is not measurable but which give satisfaction to customer.13. Quality strict adherence to standards of procedure (protocol).14. Satisfaction to service provider as well as consumer.15. Quality may be a set of objectively defined benchmarks for ensuring that a product/service
is of good standards to benefit the end user and certainly not harm him/her, while also being perceived as of good standards by the end user.
16. Quality means to me the most effective way delivering a service which gives maximum output which minimum input.
17. Perfection or excellence
Participant’s Perceptions by Group-II are as follows:1. Quality means a well accepted protocol strict adherence to it.2. Quality means optimal effective beauty of the event/parameter.3. Quality refers the content.4. Quality it is a relative term evaluated against attain in? /parameter.5. Pre-decided criteria at affordable price.6. Quality services can be defined as a “ services in which is scientifically proved to be result
oriented with least advertising”7. Quality is that component in any service or activity which makes both recipient and
provider satisfied and outcome is as per the expectations.8. Quality the level best in any field9. IPHS Indian public health standards 10. Quality- mark of efficiency, mark of perfection, mark of assurance and a scientific
gradation
24
11. A tool to measure input and output.12. The concept and proactive diagnosis and management of diseases has to be changed as per
new concepts and methods of diagnosis under NRHM that is the quality of health management.
13. Quality is appropriateness of content and way of delivery leading to best possible outcome.14. Quality with reference to health care Assessment of performance of an activity /program on
the backdrop of expectations.15. Effective services given to needy people that is very helpful to them.16. Quality is: - Planning, implementation, coordination of an activity with accuracy, diligence,
consistency, with optimal use of resources, and ensures that the desired objectives are achieved.
17. Quality means scientifically sound technology used in a way that satisfies the user as well as gives good outcome at right time, for the right person, at reasonable cost.
18. Quality of care? Role of the medical colleges in improving quality care in areas line family planning maternal and child health areas.
25
Annexure-VI
Critical issues in quality of Health & F.W. services
GROUP – II
MATERNAL HEALTH & FAMILY WELFAE
Group Representative: - Dr. Chinmaya Pataki
PROBLEMS PROVIDER SYSTEM BENEFICIARY
MATERNAL PROBLEM1. Anaemia Ignorance
Take for granted Lack of
protocol(implementation) Quality of iron preparation
Non compliance Ignorance Illiteracy
2. Bleeding in 1st trim
No counselling Lack of
expertise/knowledge
Lack of diagnostic facilities OTC Drugs available for
termination of 1st trimester Pregnancy
Non compliance Ignorance Illiteracy Gender
discrimination 3. ANC &
Immunisation Lack of motivation Financial incentives
Lack of protocol
4. High Risk pregnancies PIH/APH
Blood transfusion practices
Referral and transportation facilities for patients and Health provider.
Reluctance
5. Delivery Lack of resources Janani Suraksha yojna Institutional
26
services deliveries not 100%
6. Post partum and lactational
Lack of follow up protocol
7. Family planning unregulated pregnancy
Lack of counselling/motination
Tubectomy more popular than vasectomy.
Lack of protocol implementation
Unmet need of contraception ignorance.
8. Sociocultural and gender issues.
Maternal death audit Management of near
“miss”9. Capacity
Building EmOC BEmOC
GROUP - III
CRITICAL ISSUES OF HEALTH SYSTEM
Group Representative: - Dr. Payal Laad
1. Non uniformity of the Health Services.2. Existence of the mixed pattern across the country.3. Inadequate budgetary provision in both – allocation and utilization. 4. Development is not Health Centric.5. Non regulation of private sector.6. Lack of political will.7. Skewed doctor to patient ratio. 8. Lack of emphasis on health impact of industrialization and urbanization.9. Lack of baseline health census.10. Lack of data management.11. Ill equipped community based health insurance.12. Ill focused role of media.13. Non existence of co-ordination between medical colleges and public health.14. Frequent change of man power.15. Bureaucratic red tapism over technical heads of health programmes and medical education.16. Management training.
27
Annexure- VII
Experience Sharing
1. DR. ARUN HUMNEProfessor & Head, Community Medicine, Govt. Medical College, Nagpur-440003, Maharashtra
The experience sharing is related to evaluation of mother NGOs and field NGOs under NRHM, funded by State Health Systems Resource Centre, Pune.
Expected investigators for this evaluation were medical social workers/interns. We utilized services of post graduate students of community medicine, who did qualitative analysis alongwith structured evaluation as per predesigned proforma.
The last unit to be evaluated by us was the village of FNGO, where we arranged meeting of project coordinators of MNGO and FNGOs, ANM, AWW and PRI office bearers and local leaders.
The scenario prior to this meeting was that ‘There was lack of co-ordination between these agents of health care delivery system.
With this joint meeting the whole village came to know all details of MNGO & FNGO scheme, their job responsibilities. All the stake holders at periphery accepted that there would be profound effect, of course beneficial to achieve the objectives of the MGNO scheme.
The baseline data about the beneficiaries is with us and our team of investigators is prepared to perform the evaluation after 6 months, in those villages without asking for additional funds from the sponsors. The PGs have donated the remuneration they received for the present evaluation, so the same could be used for transportation during next voluntary evaluation planned after six months.
This has been done for 3 districts. If this model of joint venture and coordinated efforts of health personnel, FNGOs & PRIs works to improve the quality of health care, the same can be replicated at other places.
Post graduates are thinking of using the money saved (remuneration after expenditure on voluntary evaluation) for improvising the PG seminar rooms.
2. Dr. R.R. ShindeProfessor & Head Department of PSM, G.S. Medical College & KEM Hospital, Parel, Mumbai – 400012
Project title : Establishing Integrated Disease Surveillance Programme in the hospital involving clinical departments coordinated by PSM department.
Task : Mainstreaming IDSP in the hospital
28
Introduction: IDSP is one of the flagship programme of Government of India, promoting quality data management in disease surveillance. The focus is ensuring uniformity, standardization, reliability, accuracy, consistency & diligency in disease data collection, compilation, analysis and public health applications.
Clinical specialists are rarely proactive about preparing periodic morbidity / mortality reports and generally dissociate themselves from this activity citing their main focus on technical case management. Further, PSM department was viewed as non-clinical department and the clinical specialist were inclined to place the entire responsibility on PSM Department and evade ownership of the programme. The existing situation in the hospital indicated that the “Institutional” nature of “IDSP” would be grossly overlooked and then, there was a possibility of the programme being reduced to an “activity” of a department (PSM).Hence, a strategic plan of action was necessary to meet this challenge effectively. This strategic plan is being presented as “Good Practice” strategy.
Situation Prior to Establishment of IDSP
1. Conventional case papers, indoor papers, report formats2. No emphasis on quality of generating case records3. No supervision or cross-check of case record contents4. Confirmed diagnosis often not mentioned clearly on indoor case papers.5. Case-history, treatment, procedures, recorded inadequately.6. Case definition and treatment protocols now followed uniformly in all medical units.7. No accountability of record maintenance.8. Medical Records Department Staff not trained regarding accuracy in recording patient data
(very often address written inadequately)9. Clinicians / resident doctors were very reluctant & termed the progress as “clerical job”10. The staff nurses, matron, residents viewed it as additional burden.11. Laboratory staff expressed displeasure of writing “more” on paper.12. No mandate for submission of records or reports on a daily basis.13. Medical Supdt / AMO on call not involved in disease report preparation.14. No coordinating committee for disease surveillance reporting.15. Collaboration with public health department for follow-up surveillance action not
formalized.16. Resident Medical Officers not sensitized regarding IDSP.
In view of the above circumstances, the Strategic Approach adopted as follows:-
1. Promote the program as “Institutional” rather than PSM Department programme pro-actively.
2. Team approach essential, so a coordination committee formed involving PSM, Medicine, Paediatrics, Microbiology & Medical Records Department with Principal as Chairperson & PSM as member secretary.
3. The action plan for coordination was outlined.4. The “curative”, “preventive” components of surveillance were identified & departmental
responsibilities were outlined, identified & departmental responsibilities were outlined and linkage with public health department was outlined.
5. The Dean & Director was updated & emphasized about the “Institutional mandate” & meeting of concerned department convened in presence of Dean.
29
6. The micro plan was explained and an IDSP unit was located in hospital near the casualty area. It was proposed that this IDSP unit will be converted into Disaster Management Control room, during disasters.
7. The registration counter & emergency services were identified & geared for involvement in IDSP.
8. Meeting of faculty staff of concerned department held.9. The above meeting lead to preparation of a case-definition & treatment protocol manual for
clinicians.10. All RMOs were oriented in IDSP and their role in reporting. The need for clearly writing
the confirmed diagnosis on indoor paper was stressed.11. The Medical Records department staff was sensitized on the need for accuracy in recording
data.12. Additional equipment for rapid blood investigations was installed.13. Separate proformas for compiled reporting were devised to facilitate easy record of IDSP
cases in the words (to used by clinical residents) and also for coordinating weekly & monthly compilation of reports (to be used by PSM Department)
14. Meeting convened with Executive Health Officer, public health department, to outline responsibilities of Insecticidal officer, MOH I/c of wards, to work with PSM Department for surveillance actions.
Core function of IDSP in the hospital:-
1. Identify – confirmed disease cases and document the same (clinicians)2. Epidemiological investigations of cases & deaths and prepare spot map off cases (PSM
Department)3. Implement surveillance actions in the community from where the cases have been located in
the spot map along with public health department.4. Reporting on daily basis; timely, accurate, diligent.
Strategic Interventions for Implementation
1. A stamp of enlisted IDSP cases was prepared and all emergency case papers were stamped with it.
2. If a patient reports to emergency services the RMO on duty examines & decides whether the case is an IDSP case or not based on his clinical acumen. It is an IDSP case, he / she will mark on the IDSP stamp.
3. The patient then goes to registration counter. If the clerk, finds that case-paper is ticked as “IDSP” case, he records the case in a separate IDSP register and takes due care to write details of address of the patient. The patient then gets admitted in the indoor ward; clinical unit and his record is entered in ward register by the staff nurse.
4. The RMOs on duty in wards receive all the emergency lab reports of this patient after about 2-3 hours. He is then able to make a confirmed diagnosis. If not, he reports as “probable” diagnosis.
5. The compiled report of all such cases is sent in the proforma devised for clinical wards to the control unit (IDSP). The interns posted assists in the same.
6. The PSM department RMO, visits registration counter to note all IDSP cases of the day and also clarifies queries regarding data, with the RMO in the ward on phone.
30
7. A team of PSM resident, AMO on call, Lecturer on call meet in the evening at 8 p.m. and again at 6 a.m. next day to update the compiled report of IDSP cases.
8. The copy of complied report is sent to Deans residence for his information and media management in the morning at 7.30 a.m.
9. The Dean sends the approved compiled report in his office at 8.30 a.m.10. This report is collected by the control unit through the AMO posted in Deans office11. The compiled report is finalized as reporting of “probable’ and “confirmed” cases and faxed
to IDSP Head Quarters for Mumbai City (Kasturba Hospital) which in turn faxes a combined report of Mumbai city to State IDSP unit.
Preventive component
1. The cases are recorded on spot map of Mumbai from their address.2. A mobile van reports to the given address for initiating surveillance actions. (PSM residents
intern, surveillance workers from public health department).3. Deaths of IDSP cases are investigated epidemiologically by PSM residents, to ascertain
courses contributing to death.
USP of IDSP strategy
The faculty of PSM and residents conduct a preventive OPD in KEM Hospital daily. All new patients & patients on chronic management are first referred to preventive OPD. The preventive OPD undertakes screening, counseling, health education, treatment of uncomplicated cases. The Medicine & Paediatrics OPD is on the same floor and hence, where essential, immediate escorted referral of cases is possible.
This has facilitated cooperation & active participation of clinical faculty in IDSP. At institutional level, PSM department has assertively introduced role of PSM faculty as “Doctors of Health” and role of clinical specialists as “Doctors of Disease”. In public health terms, clinicians are now referred as specialists of secondary & tertiary prevention.
Collateral benefits
1. PSM department involved by clinical departments in integrated teaching.2. AMOs from clinical departments consult PSM faculty to validate research designs of their
dissertation.3. Psychiatry department / OBGY department / Paediatric / Medicine department are proactive
in participating in community health camps in rural & urban areas.4. AMOs from clinical department are deputed to urban health centres from community
orientation.5. Students from foreign universities seeking “observership” training in clinical departments
are essentially sent to PSM department for orientation of community based health program.6. PSM faculty is represented in key positions on the committees viz AEFI, Epidemic control
task force of Public health department and committees at the institution viz. patient education cell, ethics department, staff society, Research Society, Sexual harassment, redressal committee, Academic Committee and various enquiry committee.
7. Post of contractual data entry operator sanctioned and provision for expenses made for IDSP unit. Further, the location for IDSP unit / control unit ensured in developmental plan of hospital.
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8. Team from NICD visited IDSP unit in 2008, reviewed and endorsed IDSP strategy in hospital PSM department was included for conducting TOTs in IDSP and the model was discussed at NICD.
3. Dr. Dinesh BhanderiDepartment of Community Medicine, P. S. Medical College, Karamsad
Evaluation of the government health care services Anand District
Objectives of Survey:
To evaluate the government health care services provided to women in reproductive age and children under three years age in Anand district.
Minimum 40 or more households were surveyed in each cluster.
The survey was continued in each cluster till: Total eight children in age group 12-23 months were found At least two antenatal mothers in last trimester were found At least five postnatal mothers who delivered in last trimester were studied.
Results
Total 1283 families were surveyed.
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Distribution of children of age less than 3 years according to place of birth
Place of birth Children of Age (months)0-11No.(%)
12-23No.(%)
24-36No.(%)
TotalNo.(%)
37(19.9) 75(28.5) 28(26.4) 140(25.2)Govt. health center(SC, PHC,CHC)
52(28.0) 74(28.1) 35(33.0) 161(29.0)
Govt. District hospital
3(1.6) 10(3.8) 3(2.8) 16(2.9)
Private hospital 94(50.5) 104(39.5) 40(37.7) 238(42.9)Total 186
(100.0)263(100.0)
106(100.0)
555(100.0)
Maximum number of children (42.9%) were born in private hospital.
Birth weight of 429(77.3%) children was measured. 85(20.3%) were low birth weight i. e. less than 2.5 Kg. Mamta card was available for 304(54.8%) children. In case of 78(14.1%) children, though the card was provided, the mother lost it.
33
• Mamta card was available for 304(54.8%) children.• In case of 78(14.1%) children, though the card was provided, the mother lost it.
Majority (63.5%) of the children were immunized at government health centers i. e. SC, PHC, CHC or district hospitals
Vaccine % Vaccine CoverageNFHS-3
MICS Gujarat IndiaRural
IndiaTotal
BCG 97.0 86.4 75.1 78.2DPT-1 97.3DPT-2 93.5DPT-3 89.7 61.4 50.4 55.3OPV-1 97.0OPV-2 95.8OPV-3 93.5 65.3 76.5 78.2Measles 88.2 65.7 54.2 58.8Com immu 84.5 45.2 38.6 43.5
Vaccine Coverage
Vaccine % CoverageDPT(booster dose)
89.6
OPV(booster dose)
90.6
• All the 555 children except two were ever breast-fed.• Out of 553 children who were breast fed, 343(62.0%) received it within the first hour of
life. • 502(90.5%) children of age less than 3 years were registered at Mamta diwas.• However, only 295(53.2%) children were taken to Mamta Diwas Kendra regularly. • 64(11.5%) children were never taken to Mamta Diwas Kendra.• Only 125(22.5%) children received Mamta card, and out of that, parents of only 44(7.9%)
children were able to show this card to the survey team.• Out of 42 children having Mamta card & being taken to Mamta Diwas Kendra, the weights
of only 15(35.7%) were plotted on growth chart during the last visit to Mamta Diwas Kendra.
• Parents of 11(73.3%) out of these 15 children were explained regarding the weight of their child plotted on growth chart during the last visit to Mamta Diwas Kendra
• During the last visit to Mamta Diwas Kendra, parents of 396(80.7%) children were given advice regarding their feeding.
• Majority(63.8%) of the children were found to be registered at Anganwadi• 313(76.9%) children of age nine months or more had received vitamin A around Diwali
time. • Out of these 313 children, vitamin A supplementation was recorded in Mamta card of only
107 children. • Out of the 102 pregnant women, 87(85.3%) were registered at Mamta Diwas & 77(75.5%)
had Mamta card.• Weight of 83(95.4%) pregnant women was measured during their last visit to Mamta Divas
Center, out of which, in 57(65.5%) women, it was found to be noted in Mamta card.
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• Blood pressure of 71(81.6%) women was measured during the last antenatal check up. • 88(86.3%) pregnant women were immunized against Tetanus. It was recorded in Mamta
card of 74(72.5%) women. • Though 77(75.5%) pregnant women received Iron tablets, these tablets were actually seen
only in case of 34(33.3%) women. • 61(79.2%) out of 77 pregnant women were swallowing these tablets daily
Distribution of pregnant women of age15-45 years according to their knowledge of Chiranjivee Yojna
Knowledge of Chiranjivee Yojna Women No. (%)Complete knowledge 1(1.0)Incomplete knowledge 11(10.9)No knowledge 89(88.1)Total 101(100.0)
Distribution of pregnant women of age15-45 years according to their knowledge of Janani Suraksha Yojna
Knowledge of Janani Suraksha Yojna Women No. (%)Complete knowledge 1(1.0)Incomplete knowledge 9(8.9)No knowledge 91(90.1)Total 101(100.0)
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Institutional delivery rate was 80.5%
Place of delivery Women No. (%)Home 37(19.5)Govt. health center 52(27.4)District Govt. hospital 4(2.1)Private hospital 97(51.0)Total 190(100.0)
LSCS rate was 15.3%
• Out of 64 eligible women, only 6(9.4%) women got the benefit of Chiranjeevi Yojna• Out of 123 eligible women, only 25(20.3%) women got the benefit of JSY• Duration of hospital stay was comparatively longer in women who delivered normally in
private hospital (p<0.01).
Distribution of postnatal women (during last one year) of age15-45 years according to the postpartum visits
Postpartum visits Women No. (%)First 79(41.6)Second 11(5.8)Third 18(9.5)Nil 82(43.2)Total 190(100.0)
Distribution of postnatal women (during last one year) of age15-45 years according to the worker who made the postpartum visits
Worker who made the postpartum visits Women No. (%)Anganwadi worker 82(75.9)ANM/FHW 10(9.3)Both 16(14.8)Total 108(100.0)
Comparison of some study results with NFHS 3 data
Variable studied MICS 2008
NFHS-III(2005-2006)
Anand District % Gujarat % IndiaTotal % Rural %
LBW 20.2 22 21.5 23Institutional Delivery
80.5 54.6(42.2 in rural area)
40.7 28.9
LSCS rate 15.3 8.5 5.6Breast feeding started within 1 hour of birth
62.0 27.8(25.3 in rural area)
24.5 22.4
Vitamin A supplementation in last six months
76.9 17.1(17.9 in rural area)
25.1 24.5
Consumption of Iodated salt
94.6 72.1 76.1 70.1
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Some observations made during MICS• In small & remote villages, the distribution of ‘Mamta card’ is not satisfactory. • Nearly half of mothers and children are not given the card even if they attend the sessions. • Inadequate supply of these cards was one of the reasons for not issuing them to the
beneficiaries. • Visits by FHW & supervisory staff were also very less than desired. • Documentation of the activities performed during Mamta Diwas in Mamta card was found
to be poor, even when they were performed e.g. measurement of Blood Pressure and Vitamin A supplementation.
• A wide gap regarding utilization of health services was found across the different socio- economic strata of the villages.
• Mamta card was not used adequately for educating the women regarding nutrition, warning signs, self-care & newborn care.
Recommendations• IEC activities to create awareness regarding various government programmes and schemes
need to be strengthened so as to maximize their utilization by the beneficiaries.• People should be made aware of the importance of BPL card & its benefit. This is
particularly essential in remote and small villages where BPL families are in higher proportion.
• Quality of antenatal and postnatal care should be monitored and supervised by the medical officers.
• Antenatal care sessions should be made more interactive. Mamta card should be extensively used for education & counseling of pregnant women &
mothers.• Supervisory staff should ensure that at least one postpartum visit is made with in 24 hours
after birth of the baby by the health worker• Presentation of completely filled Mamta/immunization card of the child may be made
compulsory at the time of school admission so as to ensure 100% vaccine coverage. • Parents of the children will also force the health workers to enter all the given vaccines and
examination findings like weight and feeding advice in the card.
It takes whole village to raise a child.African proverb
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Annexure-VIII
Presentation of the Group Work
Group- A Reproductive Health Services
Dr. Ramesh Bhosale, Dr. Kana Ram Jat, Dr. Gautam Mukhopadhyay, Dr. Anita Banerjee, Dr. Pratibha Dabas, Dr. R. R. Shinde, Dr. Sudhakar Kokane, Dr. Arun Humne, Dr. Dinesh Bhandari, Dr. Sushma Malik
Service Outdoor IndoorMaternal Premarital counseling
Pre-pregnancy counseling & careANC-Counseling & Education-History & General, systemic, abdominal, gyn. examination-High Risk Identification-Screening-
Hb, Urine, Rh, Bld.Gr., VDRL, HIV, HBsAg, Pap
RTI/STI Medical disorders
-Immunization-Advice & Nutrition- Aaemia prophylaxis-Delivery planPNC-Anaemia prophylaxis-Nutrition-BF, Baby immunization-Contraception counseling
Abnormal pregnancyPregnancy complicationsIntranatal careNormal/abnormal labourObstetric emergenciesPostpartum complicationsTertiary care to referrals
RTI/STI Counseling, education, behaviour modification, Partner counseling/treatmentCondomsHIV (ICTC Integration)Screening – VDRL, HPV, PapDiagnosisTreatmentPrevention, contact tracing(Easy access, ConfidentialityAddress barriers- socio-cultural, etc.)
Surgical treatmentComplications management
Contraception Adolescents’ Reproductive Health Education (jeevan shiksha)(Not to call “Sex Education”)Counseling of both partnersSupply of expanded basket of contraceptives
Tubal ligationLaparoscopic SterilizationComplications managementMTP Complications Tertiary care to referrals
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MTP NSVLaparoscopic Sterilization(Women’s Rights & EmpowermentChoice)
Infertility EducationCounselingInvestigationsDiagnosisTreatment(Access & Affordability Involving male partner from beginningConfidentialityAddress barriers- social, etc.)
Operative managementEndoscopy servicesArtificial Reproductive TechnologyTertiary care to referrals
Gynaec. Care etc.
Diagnosis, Treatment, Education onMenstrual disorders, etcMenopause
Care Cancer screening
Cancer- screening, treatment Cervix Breast Ovarian,Other
Blood transfusionSurgical procedures
General Quality Issues:-
Woman centered Women’s rights/ empowerment Barrier elimination- family, social,
cultural, financial, etc. Equity Stigma, confidentiality Gender issues
SPECIFIC QUALITY ISSUES
Access Choice Patient safety Promptness Technical competence Support- family, social, self help Attention to nutrition
Maternal Health
– Early registration of pregnancies.– Registration of all pregnant women.– Lost to follow up ANC women- to be
tracked and provide services to them.– Focused ANC.
– Identification of severe cases of anaemia.– Identification of pregnant women who need
hospitalization, with signs of complications during pregnancy and those needing emergency care.
– Safe abortion / MTP
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Counseling on:– Care during pregnancy.– Danger signs during pregnancy.– Birth preparedness.– Importance of nutrition.– Registration for the JSY– Availability of funds under the JSY for
referral transport.– Exclusive Breastfeeding, Weaning and
complementary feeding.– Counseling on ENBC
– Care of a newborn– Contraception– Importance of institutional delivery and
where to go for delivery (Delivery Planning)– Identification of transport in emergency– Importance of seeking post-natal care– Counseling for better nutrition– Information on RTIs, STIs, HIV and AIDS– Prevention of HIV/AIDS, STIs– Personal hygiene– Dangers of sex selection
CONTRACEPTION
– Contraception counseling– Information on use of contraceptives.– To give condoms, OCPs and other contraceptive services as per their choice to all eligible
couples.– Compensation for loss of wages resulting from sterilization and insurance scheme for family
planning.
RTI / STI
– Counseling on prevention of RTIs and STIs, including HIV/AIDS, and diagnosis and treatment.– Counseling for perimenopausal and post-menopausal problems – Information on causation, transmission, and prevention of HIV/– AIDS and distribution of condoms for dual protection.– VCTC and PPTCT services
GYNAEC CARE
– Education of girls.– Awareness activities for prevention of pre-natal sex selection, illegality of pre-natal sex
selection, and special alert for one daughter families.– Communication on the Prevention of Violence against Women, Domestic Violence Act, 2006.– Age at marriage, especially the importance of rising the age at marriage for girls.– Identification of problems of the old and the destitute.– Special attention to the vulnerable and weaker sections of society.
DATA MANAGEMENT:– Audit of deaths of women.
Mechanisms For Addressing The Quality Issues1. Use of protocols2. Setting quality indicators3. Monitoring and Evaluation, Audits4. Training HCPs in “Quality services”5. Start accreditation process6. Adequate health-man power and expertise
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7. ‘Adequate’ Training and re-trainings and feedback8. Accurate estimate of clients/beneficiaries9. GIS mapping of maternal morbidities/mortalities10. Identify causes for home deliveries11. Seniors / experts to take lead role12. Use of Media13. Use of technology- PDA, mobile, computers, telemedicine14. Involve and train local leaders- social, religious, political15. Increase people’s awareness- maternal care, RTI etc.16. Incentives to HCW17. Good practices- 6 Cs18. Increase financial allocation, creating special expenditure head19. Mobilize political will, utilizing part of budget of MPs/MLAs for health facility20. Integration with ICDS21. Involve Community Based Organizations viz. microfinance credit for empowerment22. Organizing camps- specialized, need based, screening oriented, educating23. Convergence with RTO for directives to transport pregnant women with priority.24. Linkages with National Rural Employment Guarantee Scheme25. Promotion of PPP schemes for medical or non-medical issues e.g. transport26. Contraception
a. Access- anonymous supplyb. Awarenessc. Choiced. Women empowermente. Education of adolescentsf. Postnatal counselingg. Educating religious leadersh. Political reorientation towards population policy in context of economy
Role of Medical Colleges In Improving The Service Delivery1. Tertiary level care and feedback to health service system2. Motivation and training of faculty of all medical colleges and HCPs in “Quality services”3. Development of protocols for all levels of health care delivery4. Develop referral protocol5. Maternal death audit, ‘near-miss’/morbidity medical audit6. Undertake research on relevant research question of priority areas e.g. operational,
evaluational, etc.7. Dissertations of PGs focused on national health with special reference to rural area8. Monitoring/supportive supervision and evaluation through feasible mechanisms.9. Updating UG & PG syllabi, incorporating evidence based technical strategies of
RCH/NRHM concepts and implementation framework10. Ongoing inclusion of emerging programmatic interventions in teaching e.g. PNDTA/sex
selection, gender issues, male participation, etc.11. Integrated teaching of UG/PG students within college and with program managers12. Examinations to include questions relevant to NRHM/RCH 13. Training activities- TOT, various HCPs at district/state/national levels14. CMEs15. Participation in policy making process / planning16. Develop partnership with state/district health/FW authorities to strengthen training and
improve quality services.17. Participating in developing PIP micro-planning at district/state level
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18. Linkages with social groups, NGOs19. Public education through media etc.20. Liaison between medical education and public health (MoU)21. Telemedicine resource center22. To form advocacy consortium for administrative and technical reforms.23. Collaborate with FOGSI, IAP, IAPSM
Together We Succeed To Achieve Goal of India’s Health NRHM
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Group B
Child Health Services Including Newborn Care Preventive & Curative Services
Dr. Geetanjali Jindal, Dr. Geetika Dheer, Dr. Jitendra Deshmukh, Dr. Mohan K.D, Dr. M.S Pawar, Dr. Nitin Raithatha, Dr. Navneet, Dr. R. N. Kulkarni, Dr. Sohini Bhattacharya
Objectives Enumeration of the outdoor & inpatient services Relevant quality issues Mechanism for addressing these issues Improvement of health care delivery at all levels
Outdoor services General pediatric OPD Well baby clinic High risk neonatal clinic Growth & development assessment Breast feeding counseling Adolescent services
Immunization Nutritional assessment and
counseling Genetic counseling Rehabilitation services Special clinics Side lab services
Indoor services Neonatal resuscitation NICU Nursery KMC Post natal ward
PICU Pediatric ward Pediatric emergency services Isolation services Side lab facilities
Quality issues….How do we address them?
Adequate manpower at all levels
Medical, paramedical, supportive service staff
Pediatric advanced life support
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Appropriate qualifications Induction training Inservice training CME Approximately 10% of newborns require
some assistance to begin breathing at birth. About 1% require extensive resuscitative measures
Neonatal resuscitation All concerned with newborn care! Not only
pediatricians
For pediatricians, emergency physicians, family physicians, physician assistants, nurses, nurse practitioners, paramedics, and other healthcare providers who initiate and direct advanced life support in pediatric emergencies.
Motivation, sense of responsibility, accountability, communication skills and human touch
Quality issues…
Physical Infrastructure As per the standards
Basic amenities As per the site standards
Patient friendly atmosphere
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Role modelsQuality issues…
Adequate biomedical equipment and instruments and consumables (drugs, disposables etc.) of good quality
Purchase Maintenance(AMC/CMC) Sensitization and knowledge regarding proper utilization of funds Training of the staff regarding proper handling,usage and maintenance of
equipment Back up of Biomedical engineer
Funding Adequate funds from the concerned administration Sensitization regarding proper utilization of funds Proper biomedical waste disposal at all levels as per standard guidelines Reinforcement of infection control practices
Quality issues…. Ensuring good quality services
Strict adherence to standard protocols by concerned health care providers Periodic check of quality of services provided Supervision by senior faculty Review meetings /audit Exit interviews of beneficiaries
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Record keeping
Accurate and complete documentation and record keeping
ICD -10 coding Medical certification of death Daily ward notes Data entry personnel Periodic statistical meetings
Quality issues… Ensure follow up
CounsellingFollow up cardsTracking of the lost to follow up patients (correspondence via letter, phone, home visit)
Quality issues… Health education
Counselling Audio-visual aids Use of mass media
Quality issues… Optimizing patient turn around time
Adequate manpower Adequate equipment Sensitization of staff Patient feedback Regular monitoring of the turn around time
Referral Sensitization of the peripheral health organizations regarding the importance of a good
referral What when Where
Appropriate feedback to the referring authorities
Citizen charter Proper exhibit of the existing facilities available at appropriate places
Mobile units to carry sick patients to the hospitals Mobile health unit to visit underprivileged and marginalized pediatric population
Foster homes/orphanages
Role of medical colleges in improvement of health care delivery at all levels Inservice training of the medical and paramedical staff from village levels to district levels Identifications of the various units to establish such linkages Monitoring of the impact of training at these peripheral health units Linkages to district hospitals for higher level of care via improved referral services Telemedicine facilities connecting to district and village level Research with orientation to rural areas Mobile health unit to visit underprivileged and marginalized pediatric population
Foster homes/orphanages
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Group C
Communicable And Non-Communicable Diseases (Preventive And Curative Services)
Dr.A.P.Kulkarni- Chairman, Dr.Pallavi Shelke- Presenter, Dr.P.S. Adhav, Dr. Ashok Salwan, Dr. Pankaj Patil, Dr.S.Deshpande, Dr. Omprakash Shukla, Dr.S.Choudhary
Outdoor services (OPD)1. Help desk2. Registration3. Waiting4. Examination-
-dept OPDs, -speciality OPD5. Investigations (lab, imaging)6. Education and counselling7. Pharmacy8. Notification9. Billing
10. Store –general11. Record section12. Nursing station13. Ambulatory service-interdepartmental14. Minor OT15. Physiotherapy16. Immunization and ORT corner17. Ambulance18. FP & BCC
Outdoor services (OPD)-other Casualty (with MLC section) Blood bank PRO Post-mortem and mortuary services
Indoor services1. Registration2. Wards3. Pharmacy4. Non-medical store5. Operation theatres
Anaesthesia service7. Record section8. Follow up service9. ICUs and ICCU
Supportive services1. House keeping2. Waste management3. Kitchen 4. Sterilization unit5. Laundry6. Water supply7. Cold chain facility8. Utility services e.g. telephone, bank9. Relatives accommodation (Dharmashala )
10. Security11. Telephone(EPABX) service12. Computer section (HMIS, IDSP)13. Administrative –ministerial staff e.g.
accounts14. Public address system15. Out-reach activities16. RKS and others17. MSW services
Issues MCI norms as per no. of students not work load Norms for teaching not for hospital services provided for support staff Tertiary care hospitals compelled to primary care services
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Red tapism Lack of formal managerial training and Communication skills Lack of SOPs and protocol No updating and timely information regarding changing guidelines of health care
Tools for quality monitoring and evaluation
MCI and nursing council norms Accreditation norms e.g. NABH, NABL TISS norms? Not yet accepted by GOI Quality assurance committee Grievance redressal committee RTI Internal, external audit- financial,
performance MET cell, CME points Ethical and research committee(Inst
Research and Review board)
Periodic reports and interim assessment Death audit Performance budget Citizen charter Various committees- HICC, purchase
committee Staff grievances redressal Outsourcing G-OPD Operational research Using existing norms and standards e.g.
ISO, Blood bank, FDA norms
Linkage mechanisms Liaison officer Inclusion of public health specialists in services provided by medical college Inclusion of medical college specialists in services provided by public health personnel referral feedback mechanism e.g. IMNCI, DOTS, ASHA Training and updating of para-medicals, medical officer and other public health officials Public-private partnership Collaborating with PRI at peripheral level Liaison with HFWTC RCH mela, out-reach camps e.g. prevention of blindness, cancer detection
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GROUP - D
Supervisory Check List For Quality Services During VHND
Dr. Deepak Phalgune, Dr. Vijay Kamale, Dr. Seema Anjenaya, Dr. K. R. Shah, Dr. Bidyut Kumar Basu, Dr. Moneet Walia, Dr. Anjali Edbor, Dr. Chinmaya Pataki, Dr. Payal Laad
Village Health Nutrition Day (VHND)Once a monthHub of services in RCH II, NRHMInter-sectoral convergencePlatform for interfacing between community & the health systemRoles of ASHA, AWW , ANM well redefinedOutcomes should be measured and monitored
INTRODUCTORY INFORMATION
Name of the VillageName of the Sub centreName of the PHC
Date of visitName of the BlockName of the DistrictName of the State
INFORMATION ABOUT ASHAName of the ASHAQualificationYears / Months of serviceTraining received - Y/NDisbursement of incentives for mobilizing clients - Y/N
INFORMATION OF AWWName of the AWWQualificationYears / months of serviceTraining received - Y/N,
If yes, Induction / IMNCI/any otherRemuneration amount whether received regularly - Y/N
INFORMATION OF ANMName of the ANMYears / months in serviceTraining received If Yes (SAB / IMNCI any other ) - Y/NMarried - Y/N From Govt. Setup / Contractual
VITAL INFORMATION
No of deaths in last month– 0-2 months – 2m – 5yrs
No. of marriages No. of child marriagesNo. of new births
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– Maternal Causes of the death
MATERNAL HEALTHNo. of families SC/STNo. of families of SC/ST ASHA visitedNo. of pregnant women registered ( List)No. of women registered before 12 wks of pregnancy (list)No. of women having high risk pregnancy (list)No. of pregnant women having two living children (list)No. of high risk pregnancy women referred to PHC for check up
MATERNAL HEALTH…No. of mother beneficiaries of JSY and amount givenNo. of pregnant women checked for– Blood pressure– Hb– Urine examinationNo. of women received TT - one dose & two dosesNo. of women received IFA and how many
MATERNAL HEALTH…No. of pregnant women received counseling for – Care during pregnancy.– Danger signs during
pregnancy.– Birth preparedness.– Importance of nutrition.– Institutional delivery.
– Post-natal care.– Breastfeeding &
complementary feeding.– Care of a newborn.– Contraception
Identification of referral transport if needed Identification of nearest FRU/DH for referral ( Distance from the village)Availability of funds under JSY for referral transport and the amount given
POST NATAL CARENo. of visits to the house post delivery and days of visitsNo of visits to the house in cases where newborn was underweight and days of visit
FAMILY PLANNINGNo. of eligible couples in the village No. of eligible couples using contraception– spacing – condoms /OC pills / IUCDs– permanent methods - Tubectomy / vasectomyNo. of condoms distributed in a monthNo. of OCPs distributed in a monthNo. of IUCDs inserted in a monthNo. of tubectomies and vasectomies performed in a month
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CHILD HEALTHNo. of LBWsCounseling for care of newborns and feeding - Y/NNo. of primary immunization given
– BCG – OPV-0,1,2,3
– DPT- 1,2,3– MEASLES & Vit A
Infants up to 1 year:No. of infants completely immunizedNo. of infants regularly weighedNo. of infants reporting AEFINo. of infants with malnourishment grade III & IV (list)
Children aged 1-3 years:No. of children who received Booster dose of DPT/OPV. No. of children who received Second to fifth dose of Vitamin A No. of children who received Tablet IFA - (small) to children with clinical anaemia.No. of children who were weighed regularly.No. of children who received supplementary food for grades of mild malnutritionNo. of children who were referred for severe malnutrition (list).
All children below 5 years:No. of missed children tracked and vaccinated by ASHA and AWW.No. of Cases of diarrheaNo. of Cases managed for diarrheaNo. of ORS distributedNo. of Cases of diarrhea referred to PHC / FRUNo. of cases Acute Respiratory Infections.No. of Cases of ARI referred to PHC / FRU No. of mothers counseled on home management and where to go in event of complications.Organizing ORS depots at the session site - Y/NNo. of mothers counseled on worm infestations
RTI & STIsNo. of sessions on counseling on prevention of RTIs and STIs, including HIV/AIDSNo. of cases referred for diagnosis and treatment of the same No. of women counseled for peri-menopausal & post-menopausal problemsReferral for VCTC and PPTCT services to the appropriate institutions.
SANITATIONNo. of households having the sanitary latrinesNo. of households identified for the construction of sanitary latrinesNo. of households guided on Total Sanitation Campaign No. of breeding sites identified for mosquitoes No. of households mobilized for community action for safe disposal of household refuse and garbage
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WATER SUPPLYNo. of households having the access to safe water supply No. of days chlorination of well is performed in a week
COMMUNICABLE DISEASESNo. of group communication sessions held for raising awareness about signs & symptoms of leprosy, suspected cases, and referrals. No. of depots for collection of blood film for MP and presumptive treatment.No. of sessions on awareness generation about TB No. of symptomatic sent for sputum examination at the nearest health centreNo. of patients provided with DOTS No. of unusual numbers of cases of any disease or disease outbreak reported in village
GENDERNo. of sessions held for prevention of pre-natal sex selectionNo. of sessions held on prevention of violence against WomenNo. of sessions held on age at marriageNo of women married before the age of 18yrs
HEALTH PROMOTIONNo. of sessions held on :
– Tobacco chewing– Healthy lifestyle– Proper diet
– Proper exercise– Food that can be grown
locally
Check list of VHNDNo. of women came for the VHNDNo. of pregnant women came for the VHNDNo. of lactating mothers came for the VHNDNo. of women attended having under 5 childrenNo. of women attended with malnourished childrenNo. of malnourished children in need of supplementary nutritionNo. of malnourished children availed supplementary nutritionNo. of patients suffering from TuberculosisNo. of patients came to collect DOTS
Inspection of AWCleanlinessVentilationLightSafe drinking waterPlace of privacy for ANCNo. of MCH cardsToys and other things for NFPSECharts, posters, photographs Vaccine supply available - Y/N
– OPV - DPT - MeaslesStorage of vaccine vials – Appropriate – Y/N
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Cold chain maintained - Y/NIce packs available - Y/NPlace of giving vaccination – Satisfactory – Y/N
Inspection of VHNDM.O. present – Y/NANM present - Y/NMPW present - Y/NSchool teachers present - Y/NSarpanch / PRI member present - Y/NVillage Health and sanitation committee members present - Y/NSHG present - Y/NNGO ( If applicable) members present - Y/N
Instruments
Examination tableBed screen/ CurtainWeighing machine scale – Adult ChildChecking of weighing machine for accuracy
BP instrumentChecking calibration of BP instrumentStethoscopeMeasuring tape
Gloves availabilitySyringes and needles , disposal of themFoetoscopeHb meter
Kit for urine examinationLaboratory consumables, eg. Stain, SlidesIEC material
Medicines
Vit AIFA tabsORSTab CotrimaxazoleAntihelminthic drugs
DOTSTab ParacetamolCondomsOCPs (ECPs)AYUSH Home remedies for common ailments
PublicityVHND programme schedule displayed & disseminated - Y/NTiming of VHND programme Wall writing on local languageHoarding present - Y/NHandbills , pamphlets distributed - Y/N
Client satisfactionExit interviews with 5 clients ( 1 pregnant mother, 1 lactating mother, 1 each Adolescent girl & boy, 1 Post menopausal woman)
Focus Group Discussions Interviews regarding dates of repeat visits for immunization, birth preparedness and the institution identified for delivery.
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Annexure- IX
Suggestions given by Participants to involve Medical Colleges in NRHM
A. Maharashtra Name of Participant : Dr. R.R. Shinde
Department : Preventive and Social Medicine, Prof. / Head, G.S. Medical College, Mumbai
1) Involve faculty of PSM department in training programmes as (TOTs) resource persons at state and district and national levels.
2) Recognize Rural Health Training Centres affiliated to PSM department – Medical College as a component of primary health care system and provide funds structural and functional upgradation. The staff can be utilized for evaluation and research.
3) Medical Colleges located in metro cities (e.g Mumbai) serve as apex institute, catering to rural populations in the state. Hence, should receive funds, as per provision for a district hospital in NRHM.
4) Faculty of PSM (Professors) to be involved as members of Quality Assurance Committees under NRHM.
5) Faculty can undertake monitoring, evaluation and research activities to create evidence for strategic modifications.
6) Faculty can be involved as planners to assist state/district, to develop PIPs7) Postgraduate students can be given “dissertation” assignments for M/D. / D.P.H. course
on “NRHM “ issues and the same may be considered for financial support.8) “NRHM” newsletter can be developed at state level to include updates / progress of
NRHM, involving PSM faculty as Editors / editorial team members.9) Promote formation of state level public health consortium, affiliated to National Public
Health Consortium, of NIHFW to create advocacy platform for NRHM, thereby average as stakeholders in policy development.
10) Document the role of medical colleges in NRHM (govt.) circulars, generated at National / State levels through health secretary / Mission Director. A letter indicating inclination or directives to the state to involve medical colleges (especially PSM faculty) at all levels for technical and managerial support in NRHM.
11) Issue directives to universities to include NRHM in Medical syllabus for UG/PG courses in PSM, Gynaecology and Obstetrics, Pediatrics.
Name of Participant : Dr. Mohan DoibaleDepartment : PSM Department, Govt. Medical College, Aurangabad,
Maharashtra
1) NRHM – policy making at all levels.2) Quality Assurance Committee – state and district level3) Training and evaluation at district level4) Rural Health Training Centres under PSM department of Medical Colleges should be
treated as FRU/CHC under NRHM and funds should be made available.5) PSM department as State Health Training Centre or Regional Training Centers should be
supported under NRHM.6) Convergence at district and state level in PIP and DLHAP.
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Name of Participant : Dr. A.P. KulkarniDepartment : Sr. Consultant, State Health Systems Resource Centre, Pune
1) Inclusion of at least one senior faculty of PSM in preparation, monitoring of district PIP (although recommended, it is not practiced actually)
2) Inclusion of faculty of Medical College in third party evaluation of programme under NRHM with monetary incentives.
3) Sanction of grant in aid to M.D (Thesis) projects as is available under RNTCP4) Inclusion of faculty in Medical Colleges in training programmes at HFWTCs, DTTs5) Preparing PIPs for Medical Colleges and allotting grants for activities under NRHM.6) Allotment of a district to a willing medical college with institute serving as “Guardian”
for NRHM.7) Currently the field practice areas of medical colleges are in ‘no-man’s-land’. They should
be given budget from NRHM which will bring accountability and their participation.8) Sensitization of Deans on NRHM.
Name of Participant : Dr. D.S. PhalguneDepartment : PSM, KEM Hospital Research Centre, Pune
1) Involvement in various training programmes under RCH II2) Formulate strategies to implement, monitor and evaluate NRHM.3) Teaching UGs and PGs regarding various aspects of NRHM.
Name of Participant : Dr. Sushma MalikDepartment : Professor (Paediatrics) Incharge – Neonatology, Nair Hospital,
Mumbai
The Medical Colleges should be involved firstly in the departments of Paed/ Obst./PSM(a) Preparation and planning of programmes at grassroot level(b) Preparation of SOP and making of protocols(c) Should be involved in the training of community health workers(d) Regular updates of all new things happening in NRHM should be conveyed to medical
colleges, so that the knowledge can be given to all UG & PGs
Name of Participant : Dr. R.A. BhosaleDepartment : Obstetrics & Gynaecology, B.J. Medical College, Pune Station
Road, Pune-411001, Maharashtra
1) Medical College Professors may be involved in policy / programme making from drafting stage.
2) Medical Colleges can be involved as Resource Centre for Tele-medicine facility.3) For training of various sort at district / State / National level, TOTs, CMEs.4) Appropriate Technology development and utilization.5) Involve in research in priority areas the faculty & large number of post graduate training
& give funding.6) Involve universities for updating syllabus.7) Arrange conferences / seminars / symposium on Health Programme like NRHM with
Medical colleges and fund it to inculcate in PG/UG students.8) Use as Intellectual capital / ‘think tank’.
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Name of Participant : Dr Anita BanerjeeDepartment : Pediatrics, Indira Gandhi Government Medical College
(IGGMC), Nagpur-440012, Maharashtra
1) Teachers to be involved in decision making.2) Training of ANMs and MOs in Medical College (deputation) and organizing workshops,
follow up.3) Protocols for management of diseases to be ascertained by the Professors from time to
time.4) Protocols for referrals and further management of those patients when they arrive at
tertiary hospital.5) Streamlining of services at all levels of health care.
Name of Participant : Dr. R.N. KulkarniDepartment : PSM, G.S. Medical College, Deptt. of PSM, Parel, Mumbai-
400012, Maharashtra
1) Medical Colleges are given valuable inputs to State health department for quality improvement in program implementations including NRHM via Quality Assurance Cells.
2) Medical colleges can be involved in pre-service training to various health functionaries.3) Medical college faculties can carry out monitoring and evaluation of health programme
run by State health departments.4) Medical colleges can admit and treat serious patients referred by peripheral health
facilities running health services.5) Medical college can develop Standard of Practices (SOP) or protocols to carry out various
treatment modalities / procedures.6) Medical colleges can offer hands on training for family welfare procedures such as lap
sterilization, minilap, NSV etc.7) Medical colleges can impart latest treatment modalities / new development in other
aspects of health care delivery.
Name of Participant : Dr. Adhav PrakashDepartment : PSM, B.J. Medical College, Pune Station Road, Pune-411001,
Maharashtra
1) Training faculty for various cadre.2) Model service provider.3) Bringing vital contents in the MBBS curriculum.4) Allotting the topics related to NRHM to PG Dissertation so that P.G will have in-depth
knowledge in these issues.5) Chairman / member of group of committee evaluating the NRHM delivery in remote area.6) To provide regular feedback (monthly or quarterly)
Name of Participant : Dr. Shailesh R. DeshpandeDepartment : PSM, State Health Systems Resource Centre, Pune
1) Dialogue between DHS & DMER of the States, facilitated by interventions at higher level. Subsequently meeting of Dean / Principal / Director may be arranged.
2) PSM departments, especially their field practice area may be given specific assignments and necessary budget through NRHM or through other appropriate budget.
3) Inclusion of NRHM issues in UG & PG curriculum after consultation with MCI, Universities and DMER.
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4) Budget provision to esp. Obst. / Gynae. & Paediatrics departments for purchase of necessary drugs and equipments.
5) District / State PIP should include contributions from Medical Colleges & proportionate budgetary provision.
Name of Participant : Dr. Chinmay PatakiDepartment : Obst. & Gynae, LTMMC, Sion, Mumbai-22
1) Involved Medical colleges HODs in Policy making.2) Revamp all Medical Colleges as it is NRHM’s responsibility also if it expects fault from
Medical Colleges to train the trainee.3) Renovate the basis facilities in Medical Colleges4) Make the training programmes. Reward based in terms of Infrastructure development.5) Stop doing quick fix like 16 weeks training to perform cesarean, rather put faculty on
deputation on monthly basis with good incentives.6) Improve Library facilities which are poorer than periphery.7) Keep track of obscene amount of money put blindly in health programmes without any
practical change.
Name of Participant : Dr. Payal LaadDepartment : Community Medicine (PSM), LTMMC, Sion, Mumbai-22
1) Rural health training centre can be given the funds under NRHM. This would help medical college function better. All medical colleges are required to have rural training centres under their administration, constraint faced is in form of funds to set up infrastructure.
2) Research done in rural field practice area should be funded by NRHM, Research and development committee. The way to obtain fund should be intimated well on website of NRHM.
3) The Quality Assurance Committee should be including technocrats from Community Medicines Dept. of Medical College.
4) Medical colleges can become facilitator for training or evaluation as a third party under NRHM.
Name of Participant : Dr. Pallavi S. ShelkeDepartment : PSM, LTMMC, Sion, Mumbai-22
1) Involving in preparing PIP.2) Protocol preparation.3) Involving them at planning, policy making level.4) Covering Rural Health Centres attached to Medical Colleges under NRHM.5) Communicating adequately and timely the changing strategies, so that it can be taught to
UG & PG students.6) Sponsoring relevant research work or model projects.
Name of Participant : Dr. Madhukar S. PawarDepartment : Principal, HFWTC Nasik
1) Involve of PSM, Obst. & Paediatric Dept. of medical college in preparation of Dist. PIP.2) Involvement concerned departments of MC for preparing training modules of various
trainings under NRHM.
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3) Research studies in impact evaluation/process evaluation of NRHM activities in Non NRHM Vs NRHM area or before and after NRHM.
4) Involving teachers of concerned dept. of MC as Master trainer /GOI for different trainings.
5) To get exposure to recent advances in health care delivery district /divisional level health authorities to be called as guest lecturer for training undergraduates.
6) Preparing SOPs, quality standards for different procedures/activities under NRHM.7) Doing facility survey with help UGs/PGs8) Supportive supervision of activities like IPHS, CHCs PHCs, SC etc.
Name of Participant : Dr. Arun HumneDepartment : PSM, Govt. Medical College Nagpur, Near Hanuman Nagar,
Nagpur-440003, Maharashtra
1) Sensitization of Directors, medical Education and Research, and the Deans is required.2) Professor and heads of Community Medicine can work as Regional Coordinator to
supervise the work of dist. Program managers.3) Regular evaluation of various schemes like ASHA, MNGO, JSY can be done by
community Medicine preferably in the month of July/August.4) Community medicine, Obst. and Paediatrics can impart training to all the workshop in
NRHM.5) Professors and Heads at least Community Medicine should be involved in all National
Health Programs right from planning through implementation. So that the details of the program can be taught to medical students concurrently as it takes some years to appear the program in text books.
6) Professor and Heads, Community Medicine Obst. and paediatrics should be on mailing list and should be updated with recent advancements in NRHM.
Name of Participant : Dr. Anjali EdborDepartment : Pediatrics, N.K.P. Salve Institute of Medical Sciences & LMH,
Digdon Hills, Hingna Road, Nagpur-440019, Maharashtra
1) Involvement of Paediatrician at the PHC level.2) Interaction of the ANM, AWW & ASHA with Medical Faculty.3) Involvement of Private Medical Colleges situated in Rural Area for all concerns.
Name of Participant : Dr. Vijay N KamaleDepartment : Pediatrics, MGM Medical College, Kamothe, Navi Mumbari,
Distt. Raigad-410209, Maharashtra
1) Orientation of Dean regarding NRHM Programmes & its importance in patient care (quality).
2) Orientation of teaching staff through emails or publication.3) Making aware of teaching staff by sending publications to library at reasonable cost.4) Displaying on NRHM website about research they wanted for improvement of quality
care at community level.5) To train ASHA/Anganwadi worker and make them aware of local accredited hospital as
well as Medical College.6) A visit to Anganwadi, sub-centre, PMC & FPV made compulsory for undergraduate
student.7) Communication skills & counseling – a practical assessment should be compulsory for
both U.G & P.G students.
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Name of Participant : Dr. Jitendra K. DeshmukhDepartment : Obstetrics & Gynaecology, Govt. Medical College, Nagpur-
440010, Maharashtra
1) As integrator between health services and NRHM.2) Facilitator in Programmes.3) Tutor for up-gradation of knowledge.4) Monitoring of services5) Accreditation of centre.6) Feedback centre – on morbidity & mortality.
Name of Participant : Dr. Seem AnjenayaDepartment : Prof. & HOD Dept. of PSM, MGM Medical College, Kamothe,
Navi Mumbari, Distt. Raigad-410209, Maharashtra
1) The medical colleges should be involved right from the stage of planning, policy and decision making.
2) Funds from NRHM should be provided to medical colleges, so that atleast the objectives of NRHM could be fulfilled in the field practice areas of medical colleges.
3) Training and retraining of faculties from dept. of PSM OBGY & Paediatrics.
Name of Participant : Dr. Pankaj PatilDepartment : Obs/Gyne, MGM Medical College, Kamothe, Navi Mumbari,
Distt. Raigad-410209, Maharashtra
1) Immediate 2) Involve medical college administration 3) Provision for LSCS and remuneration4) All family planning measures should be applied 5) Accreditation medical college hospital
Name of Participant : Dr. Sudhakar KokaneDepartment : Public Health Deptt., Govt. of Maharashtra, Principal, Health &
Family Welfare Training Centre, Pune
1) Involvement of Medical College – Especially Deptt. of PSM Gynae, Obst., Paediatric, Microbiology to prepare annual PIP for district.
2) Separate PIP for each medical college or atleast concerned about RCH activities should be prepared.
3) Orientation about NRHM of all HOD of medical college alongwith Dean & DMER.4) Medical college can be involved for preparation of Training material.5) Quarterly meeting of Director of Health Services with Medical Education Director and all
concerned Deans with specialists. 6) Convergence between ICDS, Medical, Education & Health Services, Social Welfare &
Tribal Deptt. – Monthly Review by Chief Secretary of Govt.7) Field visit arrangement to PHC, SC, CHC & District Hospital with medical College
people to give suggestion to improve health delivery system and medical college people will also be oriented there by health service people.
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B. Gujarat Name of Participant : Dr. Dinesh Bhanderi
Department : Community Medicine, Pramukh Swami Medical College, Karamsad-388325, District Anand, Gujarat
1) One faculty from Community Medicine should be a member of District Health Mission.2) Community Medicine department should be involved in PIP as well in process of
monitoring and evaluation.3) 50% of Medical Colleges are private. Their role in NRHM should be clearly defined.4) MBBS curriculum must include orientation about NRHM & some practical training.5) Faculty may be trained in quality assurance so that they can act as Consultants in that
field.
Name of Participant : Dr. O.P. ShuklaDepartment : Paediatrics, Medical College Baroda
1) Allocation of funds to Medical Colleges in N.R.HM.2) A good Quality Services Training and Workshop such trained persons be designated as
NRHM Quality Consultants.3) Medical Colleges can be involved in training & teachings
(a) EmNC training (Emergency Newborn Training) for Medical Officers – 4 months course – presently run by some Medical Colleges.
(b) EmNC training for Nurses – 1 month training4) Funds are allocated for Trainers / Trainees / One time Infrastructure Grants / Stationary
and contingency. Some of these Grants can be utilized for upgradation of Department5) Medical Colleges can be involved in
– Policy making– Advocacy– Teaching / Training of MOs / Health Workers– Evaluation– SupervisionAnd funds should be allocated for faculties / trainees plus extra funds for contingencies – so that this money is used for departmental activities. For all these activities, direct funding to the department should also go so as to enrich the department.
6) Proper services / job environment and job satisfaction including good payment vis-à-vis private Consultants so as to increase the already good motivation of Medical College teachers and a uniform policy for all Medical Colleges in the State as that of Centre including Time-bound promotion & pay-commissions.
7) For every training / teaching – funds should be allocated to Medical Colleges.
Name of Participant : Dr. Nitin S. RaithathaDepartment : Obst. & Gynae, Pramukh Swami Medical College, Karamsad-
388325, District Anand, Gujarat
1) Improvement in Medical education: Content, techniques, assessments (curriculum exam)2) Role model for different level services or create one PHC under authority of model unit
for practical demonstration– Supportive supervision – in house, in field as a third party.– Operational Research.– Maintain the SOP for integration for skill practices.– Need provision of fund for basic infrastructure, operationalisation and research
work.
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– MCI should take the lead for all above mention suggestion so they can be percolate down to appropriate authority.
– Govt. vs private medical college – to define rights and responsibilities.
Name of Participant : Dr. Dipan PatelDepartment : Paediatrics, Pramukh Swami Medical College, Karamsad-
388325, District Anand, Gujarat
1) Integrate and update the Medical Colleges about the recent activities and objective of NRHM.
2) Provision of funds to Medical Colleges to improve infrastructure of college hospitals.3) Identification of leader in Medical College to coordinate with NRHM.4) Integration of primary health care services with Medical College.5) Training of peripheral health worker by faculties of Medical College and their activities to
be supervised
C. Punjab Name of Participant : Dr. Moneet Walia
Department : Obs/Gyne., Christian Medical College & Hospital, Ludhiana-141008, Punjab
1) To prepare protocols for various high risk.2) To have short term training courses of MO (Medical Officer) in medical college.3) To organize rural camps in association with Medical College for various specialties.
Name of Participant : Dr. Ashok SalwanDepartment : Gynae & Obstetric, Govt. Medical College Amritsar-143001,
Punjab
1) Teaching regarding NRHM should be made compulsory in P.G Course in all specialties because these students are our future Medical Officers and they will handle the things better.
2) Medical Faculties in Medical Colleges should be trained under NRHM, of all specialties to impart training to the PGs of their specialties.
Name of Participant : Dr. Pratibha DabasDepartment : Community Medicine, Christian Medical College & Hospital,
Ludhiana-141008, Punjab
1) Assign a Consultant from Medical Faculty for NRHM.2) Coordination with Private Medical Colleges, peripheral health centres and their workers.
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D. West Bengal Name of Participant : Dr. Gautam Mukhopadhyay
Department : Gyneaecology and obstetrics, N.B. Medical College, P.O Sushruta Nagar-734012, Siliguri, Dist. Darjeeling, West Bengal
1) Involve faculties in Training, Evaluation and Supportive Supervision.2) Provision of some untied funds to Medical Colleges. To make students, nurses aware of
the mission, this when in service they are already updated about the mission. Communication between peripheral health service people for better service delivery.
Name of Participant : Dr. Bidyut Kumar BasuDepartment : Obst. / Gynae, CNMC, 32, Gorachand Road, Park Circus,
Kolkara-700014, West Bengal
1) Coordination between Medical Colleges and Health Service section of the state is required first and national level helps for NRHM.
2) Medical Colleges can put suggestions, work and intellectual input - to any programme in the state on Medical Science/ and also for National level.
3) 75% of our countries population resides in rural areas, so development of the rural sector is definitely needed (Health Sector).
4) NRHM – programme started in 2005 but incorporating Medical College is a late event. At last it came to Medical college better late than never for betterment of course.
5) To be incorporated in MCI academic course of MBBS and may be thought in Post graduation course.
6) A mandatory event (thing) one year rural service before giving registration by MCI or No. for doctors. MBBS rigorously to be followed probably MCI is trying.
7) The teachers of medical colleges joining NRHM project – should have some sort of directives – either promotion / monetary benefit for encouraging the teachers.
8) Let the attempt for integration of NRHM with Medical College to continue, let more teachers come to NRHM (NIHFW) programme here from other Medical Colleges
E. Haryana Name of Participant : Dr. Seema Choudhary
Department : Community Medicine, Maharaja Agrasen Medical College, Agroha, Hisar-125047, Haryana
1) The National Health Programmes existing under the umbrella of NRHM can be effectively implemented through Medical Colleges.
2) Important role in pre-service teaching and training of under-graduate and post-graduates to provide good quality health care services and implementing the programme for the State’s needs.
3) Also providing skill upgradation training and enabling the trainees not only to acquire the skills but also learn to diagnose and treat complications.
4) Knowledge and skill upgradation during in-service training for various service providers.5) Training of district and below district level trainers.6) Training of MOs of PHC/CHC (if necessary)7) Training of Specialized Skills.8) Monitoring & evaluation of NRHM can be done effectively.9) Overall involvement of Medical Colleges under NRHM will improve the quality of health
care provider through NRHM.
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F. Chandigarh Name of Participant : Dr. Geetanjali Jindal
Department : Pediatrics, Govt. Medical College & Hospital, Sect.32, Chandigarh-160030
1) Training to district and State level medical and paramedical staffs.2) Monitoring activities at district and State level regarding importance of training.3) Tele medicine services.4) Rural bases research with funds through NRHM.
Name of Participant : Dr. Kana RamDepartment : Asst. Prof. Pediatrics, Govt. Medical College & Hospital, Sect.32,
Chandigarh-160030
1) Training of peripheral workers through medical colleges2) To make protocols to be used at peripheral centre3) Funds to medical colleges also4) To improve referral system – actually patients really needing tertiary care intervention5) Medical colleges should be involved in planning methods of NRHM.
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