Team 1

SECRETARY DIRECTOR GENERAL

EXE.DIRECTOR

SECRETARY

GOVERNING BODY

MINISTER

DIRECTOR

UPPER DIRECTOR

Finance cont.

Joint Dir. RCA-1 Maternal health

Joint Dir. RCA-2 Child Health

Joint Dir. T.B

Joint Dir. Leprosy

Joint Dir. EYE

Joint Dir. HIMS

Joint dir. I.E.C

Joint Dir AIDS

I.E.C OFFICER

Minister: Head of all health activity running at the state level.

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

Secretary: Works under IAS officer. The Executive director is leading the executive committee. Secretary: Works under Executive director and is responsible for implementation of programs.

Position of Director general is divided into three parts:

A director for National Programs. A director for health and family welfare. A director for finance.

Director for National Programs

Upper director works under National Programs director. It is divided into eight departments:

Joint Joint Joint Joint Joint Joint Joint Joint

director RCH-1 (Maternal health) Director RCH-2 (Child health and immunization-IMMCI) Director of T.B Director of Leprosy Director of Eye Director of ICE- Under this IEC officers are working Director of HIMS; Director of AIDS

Director Medical & health

Upper dir. Medical treatment

Upper dir. Administrati on

Upper dir. Medic. Edu.

Upper Dir. Store

Upper Dir. Health

Upper dir. Employer

Joint dir.
Joint dir.Dru g& logistic
Drug controller Joint dir. IDSP Joint dir. Health Medical Treat. Assist. Dir.

Deputy Dir. Nursing Deputy Dir. Drug

Deputy Dir. Joint dir. faculty

Medical Officer

Medical officer
Joint dir. PPP

Assist. Dir.

The six Directors are as follows:

Upper director Upper director education Upper director Upper director Upper director Upper director

(Administrative officer) of Medical and of of of of store health medical treatment employer

Upper director(administrator)-under which all administrative work takes place. Upper director(medical education)-it helps to promote the medical education. Upper director of store-under this all drug related such as storage and quality related work is done. Upper director of health-it helps to prevent communicable and non-communicable disease, disaster management etc. Upper director (medical treatment)- under this all functions related to treatment such as EMRI, Smart card policy, Mobile etc are governed by them. Upper director (employer)-under this some employer are working and some of the engineers are also working. They help to maintain the infrastructure.

Upper director of store: The department of store is divided into further two more departments: Joint director of drugs and logistics Drug controller Upper director of health: This department is further dived into two departments:

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

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

Some others works include : Disaster Management Food License Birth and Death Certificate Registrations. Under the joint director of health two more departments are working: Deputy Director (Birth and Death) Medical Officer.

Upper Director of Medical Treatment:

It is further divided into three parts: Joint director of medical treatment: under this assistant director works n under him medical officer works. Joint director of PPP- Under this following functions are done: EMRI, Smart Card, Health policy, Mobile Van Services Joint Director of faculty: It is further divided into two groups: Deputy Director of Nursing Deputy Director of Pharmacy.

Joint Dir. Of Administrati on Assist. Dir. Of Administrati on Legal officer

Joint Dir. Of Staff officer

Joint dir. Of Trainee

Joint dir. Of Dental

Assist. Dir. Of Trainee

Assist. Dir. Of Dental

It is further divided into following groups: Joint Director (Administrative) Joint director (Staff Officer) Joint Director (Training):The trainee director has an Assistant director who works for him. Joint Director(Dental): An Assistant Director works under him.

Under joint director of administration assistant director of administration works. Legal officer works under the assistant director who helps in the court cases and the vehicle storage power.

CMO (chief medical officer)

Deputy CMO for urban setup (DCMO)

Deputy CMO for rural setup (DCMO)

Administrative officer

Medical officer (PHC) LHV (lady health visitor) (SC)

Medical Superintendent (CHC)

CMO (chief medical officer):Overall charge of general administration Discipline of medical department with smooth delivery of health care comes under CMO. He is responsible for taking budget estimate every year and submits the report to higher hierarchy. He will accompany chairperson on his inspection whenever required.

DCMO (Deputy Chief medical officer):He reports to CMO and assists him/her in the administrative department and is responsible for controlling the expenditure by following the budget. Drugs imprest charge is under DCMO He is the one who passes LTC claims of staff at medical department.

Administrative officer:He is a non-technical head of CMO office and will be directly responsible for the clerical work of the entire office. He assists CMO in general administration and discipline of official staff and can attend to any other works as assigned by DCMO/CMO from time to time.

Medical superintendent (CHC):Medical superintendents have to hold current registration with medical board or appropriate body (i.e. district hospitals) in category for which they are employed and are also responsible for ensuring good clinical governance. MS includes executive directors of medical services and district directors of medical services.

Medical officer (PHC):In addition to diagnostic and curative services medical officer acts as a primary administrator at PHC level and reports everything to district headquarters. Qualification of Medical officer must be an MBBS.

LHV (lady health visitor) (SC):LHV is entrusted with the task of supervision of 6 SC and reports to medical officer (PHC) about SC annual reports. She provides a variety of services to urban and rural communities, including basic nursing care, maternal child health services and training of community workers.

Also called as Sehat ki sawari.

*TEHRI- launched on 27th October 2005 *CAHMOLI- launched on 17th October 2004

This project have started in 2 districts-

OBJECTIVE: To initiate health care access to remote areas.

MANPOWER:

Physician- 1, Pharmacist-1, IEC assistant-1, Nurse-1, Lab technician-1, Attendent-1, Project coordinator-1, Driver-1.

Health Indicators Crude Birth Rate Crude Death Rate Total Fertility Rate Maternal Mortality Rate Infant Mortality Rate Child Mortality Rate Neonatal Mortality Rate

Uttarakhand 20.4 6.8 2.6 440 48 57 28

India 23.1 7.4 2.7 254 55 72 44

Total

fertility rate almost same to national average. Infant mortality rate , Child mortality rate & Neonatal mortality rate are also below the national average . But , Maternal mortality rate is very high (almost double).It is one of area of concern. Overall heath status is satisfactory.

Socio & Demographic Profile

Uttarakhand

India

Total Population(in millions)

Rural Population(in millions) Decadal Growth(%) Population below poverty line(%) Density (Person per sq. km) Sex Ratio Schedule Tribe Population(%) Literacy Rate(Person)

10.12
7.28 20.4 31.8 189 963 3 79.63

1210.20
730.75 281.37 17.64 27.5 382 940 16.2 8.2 74.04

Urban Population(in millions) 2.83

Schedule Caste Population(%) 18

Literacy Rate(Male)
Literacy Rate(Female)

88.33
70.70

82.14
65.46

Low population density(189/sq.km). But , population growth in decade is more than national average. Population below poverty line is more than national average. Sex ratio is in good condition. Literacy rate is more than national average. Overall we can say that socio economic profile of the state is satisfactory.

Public Health Infrastructure Number of District Hospital

Number of FRUs Number of CHCs Number of PHCs Number of SCs Average Rural Population covered by CHC

Uttarakhand 18
16 55 239 1765 114732

India 635
2463 4535 23673 147069 163725

Average Rural Population covered by PHC

Average Rural Population covered by SC Average Rural area covered by CHC

26403
3575 957.93

31364
5049 687.61

Public Health Infrastructure Average Rural area covered by PHC Average Rural area covered by SC Average Radial distance covered by CHC Average Radial distance covered by PHC Average Radial distance covered by SC Average Number of villages covered by CHCs Average Number of villages covered by PHCs Average Number of villages covered by SCs Number of SCs per PHC

Uttarakhand 220.44 29.85 17.46 8.38 3.08 306 70 10 7

India 131.72 21.20 14.79 6.47 2.60 141 27 4 6

Accessibility of these centre are also difficult because area are hilly & average radial distance is high. For example radial distance covered by PHC is 17.46 km(national average is 14.79 km). Also as Uttarakhand is hilly place which make it more difficult. So there is need to increase the number of health care institution. Here another important factor is the location of establishment.

A LOOK AT THE FIELD VISITS

GROUP NO. 1

4th Aug11 : CHC, Bassi

5th Aug11 : a) PHC, Tunga

9th Aug11 : DH, Dausa

It is headed by a PMO Total no. of beds: 150 Population covered: 20 lac No. of OPD/day: 500-600 IPD/day: 80 All major services available.

All type of general surgeries performed Total 35 doctors are present Deliveries done under JSY/day: 10 Yashoda & Priyadarshani are available Blood bank functional & blood donation camps held per month

All diagnostic & investigation facilities available except MRI Laboratory & O.T. is well equipped
Special cases are referred to SMS, Jaipur Provisions for BPL are adequate Enquiry counter & STD clinic present.

Pharmacy with all kinds of drugs including ayurvedic, homeopathic & unani drugs is present

1 public health manager is present

Family planning checkups done by doctors on routine basis through field visits

Nursery is present 14 incubators are available & usually all of them are occupied Mostly cases of jaundice, low birth weights, & malnutrition are reported

Labor room present with 50 beds & 4 doctors

No. of caesarian cases done in past 7 months: 25 12 AYUSH nurses are available (3 morning, 3 evening, 3 night, 3 rest of the time) Total 35 ASHAs are present but only 20 are working Emergency room is present

No fee for bed. Rates of OPD: Rs 5, IPD: Rs 20, X-ray: Rs 60, USG: Rs 200(full abdomen) & Rs 120(specific part) Total no. of ambulance: 2 Eye OPD with 2 eye testing machines present Medical camps are frequently organized by NGOs

4 X-ray machines & 1 USG machine availabl Centrally air-conditioned ICU in neonatal ward Round-the-clock electricity & water supply Easily accessible location

No ICU & sterilization room 1 dental chair in dental OPD, & that too nonfunctional

No pediatric surgeon & dermatologist available

Physiotherapy services not provided No diet provided to indoor patients, except milk

Labor room is over-crowded, increased chances of hospital-borne infections in neonates Used syringes are disposed undestructed just outside the hospital premises Waste disposal not done as per the government guidelines

S. No.

Personnel

IPHS norm

Current Availability

1
2 3

Hospital Superintendent
Medical specialist Surgery specialist

1
3 2

1
1+1 2

4
5 6 7 8 9 10 11 12 13

Obs & Gynae specialist

Psychiatrist Pediatrician Anesthetist ENT surgeon Ophthalmologist Orthopedician Radiologist Casualty/ General duty doctors Dental surgeon

4
1 2 2 1 1 1 1 6 1

4
1 3 1 2 1 1 1 16 1

Major specialist services available. Population covered: 25,ooo No. of beds: 30 (10 males & 20 females). Bed occupancy rate is high due to services provided. Avg. OPD: 600 (IPD- 25)/day

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

All vaccination & immunization services are provided by trained staff under doctors supervision. Waste disposal done by health care waste management on alternate days

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

Kitchen is unavailable, but food is provided by JSY. Special cases referred to SMS, Jaipur. Gynae cases are referred to Mahila chikitsalaya while pediatric cases to Jan Kalyan Hospital.

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

HIV counseling and promotional desk available.

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

Fees: OPD- Rs 2, IPD- Rs 5, ECG- Rs 30, USG- Rs 165, Dengue- Rs 240, X ray- Rs 60 Full time electricity and water availability. Positive patient feedback regarding Doctors services.

Block CMO and NRHM health manager desk available.

500-600 deliveries per month,but only 1 gynae available. Non availability of full time Anesthetist, eye surgeon, public health program manager. Drinking water source unhygienic. Blood bank nonfunctional

Overall cleanliness and hygiene unsatisfactory. Building is under construction due to expanding infrastructure, may lead to some accident.. Electricals and circuits uncovered. Lack of ventilation and sanitation facilities.

S. no. 1

PERSONNEL

IPHS norm 1

CURRENT AVAILABILIT Y

General surgeon

2
3 4 5 6

Physician
Obstetrician /Gynecologist Pediatrician Anesthetist Public health programme manager

1
1 1 1 1

1
1 1 1

7
8 9 10 11

Eye surgeon
Medical officer ANM Nurse/Midwife & Staff nurse Wardboys

1 7 2

3 5 10

12

Data entry operator1

All facilities are available(proper data handling, proper store, laboratory & labour room) Total OPD: 90-100/day No. of beds: 6

Other services like nutrition services and school health programmes are also available

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

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

A day for immunization is fixed and the sessions are held as per government guidelines. Residential facilities available for female health workers. Lab equipped with microscope, tests are carried out for malaria & TB but not for HIV

Patients are referred to: CHC, Bassi TB centre, Shastri nagar Medical college, Jaipur

National programmes available: AIDS control and TB control program. Save the girl child program also in progress.

Quarter for AYUSH is available but services are not provided. Hospital waste being dumped within premises. Overall cleanliness is good but not in labor room. Pharmacy for drug dispensing and storage is not available.

S. No. 1

Personnel
Medical officer

Recommended 2( one may be AYUSH & one may be Lady M.O.)

Current Availability 2

2
3

Pharmacist
Nurse- midwife(staff nurse)

1
3( one foe 24hrs and 2 on contractual basis) 1 1 2 1

1
1 ANM 2 GNM

4 5 6 7

Health worker(female) Health educator Health assistant Lab technician

6 1

Population covered: 5,000 Immunization sessions held as per government guidelines. Family planning checkups & survey done on routine basis. Ante natal care services delivered. First aid services provided. Free distribution of oral contraceptives.

Drugs like PCM, citrizine, metrogyl, & DOTS available. ORS given to children suffering from dehydration & diarrhea. Co-ordinated services with AWWs, ASHA, Village health & sanitation committee are provided. 1 health worker & 1 nurse present. Overall infrastructure is satisfactory.

GROUP NO. 1