PROJECT PROPOSAL ON PRIMARY HEALTH CENTRE (PHC)/ TRAINNING PROGRAMME

Part - I Name of Organization Address of Organization Contact No. & E-mail Bank Details : HUMAN LIFE SOCIETY : Sagar Market Moti Lal Road, Deoria, Uttar Pradesh - 274001 : +91 9532331119, +91 9532330836 humanlife2011.org73@yahoo.com : Bank Name – HDFC Bank Account No. - 094714500000092 Society Regd. No. PAN 12 A & 80G Regd. : 1452, 13/01/2011 : AAAAH8267M : 12A Regd. No.- G/12A/2012-13/1687 80G Regd. No. – G/80G/2012-13/1687 Project Area : Uttar Pradesh

Part - II

INTRODUCTION Primary Health Centre is the cornerstone of rural including slum India health services - a first port of call to a qualified doctor of the public sector in rural areas for the sick and those who directly report or referred from Sub-Centres for curative, preventive and promotive health care. The concept of Primary Health Centre (PHC) is not new to India. We are giving the concept of a PHC as a BASIC HEALTH UNIT to provide as close to the people as possible, an integrated curative and preventive health care to the rural population with emphasis on preventive and promotive aspects of health care in the target areas of Uttar Pradesh The health planners in India have visualized the PHC and its Sub-Centers (SCs) as the proper infrastructure to provide health services to the rural population. The Central Council

of Health at its first meeting held in January 1953 had recommended the establishment of PHCs in community development blocks to provide comprehensive health care to the rural population. These centres were functioning as peripheral health service institutions with little or no community involvement. Increasingly, these centres came under criticism, as they were not able to provide adequate health coverage, partly, because they were poorly staffed and equipped and lacked basic amenities. PHCs are not spared from issues such as the inability to perform up to the expectation due to (i) non-availability of doctors at PHCs; (ii) even if posted, doctors do not stay at the PHC HQ; (iii) inadequate physical infrastructure and facilities; (iv) insufficient quantities of drugs; (v) lack of accountability to the public and lack of community participation; (vi) lack of set standards for monitoring quality care etc. So we are trying to overcome from these inability and will be organized the Primary Health Care Camp/Centre with better amenities, mobile van and infrastructure..

OBJECTIVES The objective is to improve and enhance the services offered by Primary Health Centers (PHCs) in the rural communities of Uttar Pradesh but initially in the targeted areas. We propose to do this by applying novel solutions that take advantage of developments in harnessing solar power, computers, and information technology. Our strategy is to use technology to provide effective early medical intervention, deliver expert health care, and minimize the inconvenience caused to patients and health-workers from poor logistics and long travel time. An equally important role of PHCs is to provide health education emphasizing family planning, hygiene, sanitation, and prevention of communicable diseases. Other objectives which are related to this programme: • To reduce the incidence of maternal mortality, child mortality and mortality and morbidity, dehydration and malnutrition (and to introduce sense) antenatal care, post-Natal care and Immunization services. To enhance the capability of mother to look after the normal health and nutritional needs of the child through proper nutrition and health education. (To make aware) of public health supervisor, community organizer, Traditional Birth Attendant (Dai) and volunteers of youth clubs in mother and child health and to enhance their skill and their respective rules towards service to be delivered in the project. To educate the community as to the concept and philosophy of family planning and its importance for the family, community and society and to create confidence

among the people in adopting this practice and to expedite Governmental action for promotion of various measures to meet relevant needs of the people. • To support and supplement special health related activities and preventive programs such as literacy training for female, sanitation and low cost methods of providing safe drinking water, smokeless woven, latrine etc. To encourage and support programs to integrate traditional and western systems of health care. To eradicate illiteracy and to run post literacy and continuing education program for development through establishment of functional literacy center and other complementary activities. To involve participation in the planning, implementation and maintenance of activities envisaged and to raise income levels and expand employment opportunities of the weaker sections of society, particularly of women and of those living below the poverty line. To treat needy patients particularly to destitute women and children, to admit them in the hospital for their treatment and to supply nutritious and food for bed patients. To raise the nutritional status of the community, especially mothers and children by the use of cheap, locally available and nutritious foods. To impart nutrition, education and nutrition cooking demonstration to convince mothers. To arouse adequate consciousness about health and hygiene among villagers.

OVERVIEW The long-term goal of the Indian government and international funding agencies has been to provide health care to rural communities through PHCs. However, even with large funding, these centers have not been successful for a variety of reasons that include lack of decent facilities, equipment for performing even simple laboratory tests, etc. Even more important is a social reality: there just are not enough trained and qualified doctors to adequately serve the entire urban and rural populations of India even if we could provide financial incentives for them to work in rural areas. Since we believe that the dearth of doctors willing to practice in rural areas and their reluctance to travel to, let alone live in, remote areas will continue to exist for a long time to come, we have incorporated this reality into our planning from the start as described in this proposal. Our plan, therefore, is to increase the effectiveness of doctors who are willing to work in rural areas by a large factor. This can be accomplished by reducing the need for doctors in the initial screening of patients, and by allocating one physician for every five PHCs. Simultaneously; we plan to make working at PHCs more attractive and satisfying.

The result of non-functioning PHCs has been that, in many cases, diseases are not diagnosed in their early stages nor treated. The rural population has to often travel to urban areas when they can no longer bear the suffering caused by the disease, thus increasing the load on hospitals in urban areas and ending up with serious complications that, in many cases, could have easily been treated at their early stages. The need to rectify this problem has become critical especially given the fact that over 650 million people live in rural areas across the country with poor awareness of health issues. This ignorance, coupled with the increased mobility between rural and urban areas, has led to an explosive increase in the spread of diseases like HIV/AIDS and Hepatitis B and C. We envisage PHCs functioning as the first level in a hierarchical system of health care facilities. At this primary level, PHCs will play two equally important roles: First, diagnosis of diseases based on symptoms and simple laboratory tests, and their treatment either at the centers or through referral. Second, health education leading to family planning, better hygiene and sanitation, and prevention of communicable diseases, especially sexually transmitted diseases.

HEALTH RELATED PROBLEMS AMONG RURAL POOR Urban poor suffer much poorer health status and access to healthcare. • • • • • • Lower access to institutional deliveries; Lower coverage of immunization; Higher infant mortality; Higher prevalence of child under nutrition; Higher prevalence of infectious diseases on account of poor living environment and Lower access to housing, safe water supply & sanitation.

BARRIERS LIMITING ACCESS OF RURAL POOR TO HEALTH CARE

Illegal status of Rural Poor: • Large proportion of rural poor live in unlisted slums • Constant threat of eviction • This compromises their access to basic services (water, sanitation) and to entitlements e.g JSY. Multi-dimensional vulnerability: • Irregular employment, struggle for livelihood Denial of entry / access in healthcare institutions.

Sub-optimal primary health care services: • Uneven distribution of rural primary healthcare centres • Vacant Staff positions and low motivation of workers

• •

Timings inconvenient to rural poor Weak referral linkages and emphasis on curative care than preventive.

Lack of convergence and programme experience: • Weak coordination among stakeholders • Weak urban health capacity of functionaries • Few examples of planned and well managed urban health programmes to guide and inform ongoing and new programmes. High cost of private healthcare for the poor. Weak community demand for health care: • Poor literacy and lack of awareness about services, schemes and entitlements • Poor knowledge about health and hygiene behaviours • Poor status of women leading to neglect of women’s health and lack of family support to mother / caregiver • Wide prevalence of culturally influences practices that may be harmful to health.

FRAMEWORK FOR HEALTH CARE REFORMS

Health System Research And Geography Health System Research in developing countries focuses on quality outcomes of different health care interventions like decentralization and the Primary Health Care Approach. In Geography the research in health care has been reestablished in the 18th century. From the historical development of medical geography the following issues become clear. Medical geographers research the links between health indicators and place characteristics in order to understand the features shaping the health of people. Describing ecological, cultural, religious or political circumstances of the research area is an important part of the research methodology. Comparison of regions or localities in view of their health systems or disease patterns as well as studies on spread and migration of infections can be seen as the geographical basis of the subject. In modern medical geography or ‘post-medical’ geography the emphasis has slightly changed. The development of ‘post-medical’ geography of health was advocated by Kearns. The emphasis of ‘postmedical’ geography is to take up a broader social geographic perspective in research. Social environment, socio-economic status and the perception of a place has gained importance in his view and calls for refocusing the “attention on the social context of health and disease”. Rather than concentrating on spatial distribution of health care, medical geography should focus on inequalities in health status. ’Post-medical’ geography in his opinion has come into existence through a new understanding of place which incorporates both the subjective and the objective meaning of a place. In his call

for reforms Kearns criticises the geographical approach to analyse spatial relationships without questioning the characteristics of places themselves. Medical geography has not been very influential outside its own discipline due to it “technocratic perception”. However, the discipline has much more to offer than the technologies of spatial analysis only. Socio demographic, economic, and political factors are interrelated with health. Medical geography delivers not only the instruments for multidisciplinary research but also offers a theoretical basis upon which researchers can operate. Besides logical positivism and the scientific method, medical geography can and should also use phenomenology, realism, structuralism and others to understand the underlying processes and methods which shape the health system. Research on participation and decentralization in health care is a relatively new field of medical geography which looks into the interactions between politics and health. It is part of the geography of health care delivery. Geography of health care delivery engages with health system analysis, spatial distribution of health services, planning and optimizing health care resources, project of accessibility and utilization of health services and traditional medicine. Since research on participation and decentralization deals with the social and political context of health it follows Kearns call for a ‘post-medical’ geography. At the same time it uses the strengths of other sub-disciplines of geography, like cultural or social geography. Medical geography cannot be seen as detached from geography as such. Therefore, the strengths of geography in spatial analysis are incorporated in this discipline. “Medical geography uses the concepts and techniques of the discipline of geography to investigate health-related topics. Subjects are viewed in holistic terms within a variety of cultural systems and a diverse biosphere.” The issues of medical geography explained above culminate in this definition which includes all important aspects of the discipline. The following project will analyse the process of health policy implementation of the new National Health Policy 2002 in India. The Primary Health Care Approach and decentralization are the theoretical background for health care reform in India. Both approaches incorporate participation as an important measure to enhance equity in health care and, thus, to improve the quality of the health services. Several attempts to employ community participation in past reforms have not shown the desired outcomes. The focus of this project will be especially on the involvement of non-governmental organizations, since the government policy places high hopes in them. Nongovernmental organizations are defined here as voluntary, not-for-profit organizations. The framework chosen for research is not logical positivism, which is the prevailing philosophy for empirical sciences, because its “hypothetico-deductive” method is not useful for this project. Logical positivism requires that observable and replicable objects are studied from which law-like statements can be formulated. Thus, logical statements are verified with empirical methods. While this framework is suited for studies of disease patterns, where causal relationships can be formed, it is insufficient for the complexity of policy analysis. The project will rather use a postmodernist framework, which is better suited for this purpose. The postmodernist framework is sceptical of overarching principles and against the overvaluation of causality and rationality as determinants of social processes (Wessel 1996: 30).

Although elements of critical rationalism, structuralism or rationalism prove also useful for this research and are partly incorporated in postmodernism, none of them is sufficient on its own. Theory building and falsification or verification processes, central to a critical rationalist framework, are acclaimed methods in empirical research in geography. Therefore, they will be used in this project to a certain extent. However, it is anticipated that in the analysis of participation in a diverse country like India, it might not be possible and desirable to formulate universal theories. In the search for truth as it is the case in every scientific project and also in this policy analysis, a complex answer might be more appreciated than a simple answer. This leads us to the question of validity. Participation is essential for equity in health care. Equity research in turn is an important and new field in medical geography. In the social sciences and also in social geography research in inequalities has long been established. The interest of the public health sciences in inequalities, however, has only recently emerged. The strength of geography to address spatial dimensions in social processes will be employed here for the selection of the spatial level of analysis - the district - and for an inter-area comparison. Hence, this project is soundly embedded in the tradition of geographical research, while at the same time using an interdisciplinary approach – which is another advantage of geography.

Primary Health Care Approach

Health care systems throughout the world are shaped by the historical patterns of their countries as well as by political, economical and geographical conditions. After their independence from colonial rule many developing countries inherited a health system which focused on curative care. Furthermore, it was built to care for a selected proportion of the population only, leaving out the rural poor. Although some achievements in health were reached in the 1950ies and 1960ies, infectious diseases were still widespread. By the 1970ies it became clear that the health systems in the respective countries were not able to achieve the health outcomes desired by the World Health Organization (WHO). The high prevalence of infectious diseases, high infant and maternal mortality rates in the countries of Asia, Africa and Latin America made it clear, that the inherited health infrastructure was not fit to cater for the needs of the population. It became apparent that low health status was also linked to underdevelopment, low productivity, high unemployment rates, malnutrition, and environmental degradation. Poverty was identified as one root cause of diseases. Not only the United Nations Organizations were concerned with the lack of health care in the Southern countries, but also religious institutions like the World Council of Churches and other governmental and non-governmental organizations. UNICEF and WHO called for a global conference to address these issues. In 1978 the conference was held in Alma Ata. The Primary Health Care Approach was established there and became a globally accepted policy instrument. Basic health care for poor rural populations was the main concept successfully tried there. The experiences of those countries and the

realisation that health care systems needed to change fundamentally in order to address the immense amount of health problems in the world led to the major 7 principles, which were laid out to promote equity in health care. Adaptation of the health systems to sociocultural and political conditions, a turn towards more preventive and promotive care, focus on health education and development of other health related sectors like agriculture and housing were the main points. Community participation and self-reliance at the local level were highly emphasized. In sum the Primary Health Care Approach was a paradigm change from curative, urban based care to preventive, rural based care. This change also required a new definition of health contrary to the medical definition of health. The WHO had formulated in its constitution that health “is a state of complete physical, mental and social wellbeing, and not merely the absence of disease or infirmity.” Although the definition had existed for some years, it was only after Alma Ata that its contents were translated into policy guidelines. All WHO member countries signed the declaration and were, therefore, requested to implement primary health care. The Primary Health Care Approach can be interpreted in different ways. Taking a broader view of primary health care, Green points towards the concepts of equity, community participation, a multisectoral approach to health, appropriate technology and a health promotive and preventive approach. In his view, these are the basic pillars of primary health care, which need to be operationalized for research.

The Basic Pillars of Primary Health Care

WE EFFICIENTLY TAKE CARE OF ALL POSSIBLE STANDARDS OF INDIAN PUBLIC HEALTH STANDARDS (IPHS) AS SET OUT FOR PRIMARY HEALTH CENTRE. MINIMUM REQUIREMENTS AT THE PRIMARY HEALTH CENTRE Facilities: The project includes a suggested layout of PHC indicating the space for the building and other infrastructure facilities. A list of manpower, equipment, furniture and drugs needed for providing the assured and desirable services at the PHC has been incorporated in the project. The monitoring process and quality assurance mechanism is also

included. Assured services cover all the essential elements of preventive, promotive, curative and rehabilitative primary health care. This implies a wide range of services that include: Medical care: • OPD services: 4 hours in the morning and 2 hours in the afternoon / evening. Time schedule will vary from state to state. Minimum OPD attendance should be 40 patients per doctor per day. 24 hours emergency services: appropriate management of injuries and accident, First Aid, Stabilisation of the condition of the patient before referral, Dog bite/snake bite/scorpion bite cases, and other emergency conditions. Referral services. In-patient services (beds)

• •

Maternal and Child Health Care including family planning: • Antenatal care: Early registration of all pregnancies ideally in the first trimester (before 12th week of pregnancy). However, even if a woman comes late in her pregnancy for registration she should be registered and care given to her according to gestational age. Minimum 3 antenatal checkups and provision of complete package of services. First visit as soon as pregnancy is suspected/between 4th and 6th month (before 26 weeks), second visit at 8th month (around 32 weeks) and third visit at 9th month (around 36 weeks). Associated services like providing iron and folic acid tablets, injection Tetanus Toxoid etc. Minimum laboratory investigations like haemoglobin, urine albumin, and sugar, RPR test for syphilis Nutrition and health counseling Identification of high-risk pregnancies/ appropriate management Chemoprophylaxis for Malaria in high malaria endemic areas as per NVBDCP guidelines. • Intra-natal care: Promotion of institutional deliveries

Conducting of normal deliveries Assisted vaginal deliveries including forceps / vacuum delivery whenever required Manual removal of placenta Appropriate and prompt referral for cases needing specialist care. Management of Pregnancy Induced hypertension including referral Pre-referral management (Obstetric first-aid) in Obstetric emergencies that need expert assistance. • New Born Care: Facilities and care for neonatal resuscitation Management of neonatal hypothermia / jaundice • Care of the child: Emergency care of sick children including Integrated Management of Neonatal and Childhood Illness Care of routine childhood illness Essential Newborn Care Promotion of exclusive breast-feeding for 6 months Full Immunization of all infants and children against vaccine preventable diseases as per guidelines of GOI. Vitamin A prophylaxis to the children as per guidelines Prevention and control of childhood diseases, infections, etc. • Family Planning: Education, Motivation and counseling to adopt appropriate Family planning methods. Provision of contraceptives contraceptives, IUD insertions. such as condoms, oral pills, emergency

Permanent methods like Tubal ligation and vasectomy / NSV. Follow up services to the eligible couples adopting permanent methods (Tubectomy/Vasectomy).

Counseling and appropriate referral for safe abortion services (MTP) for those in need. Counseling and appropriate referral for couples having infertility.

Management Infections: • •

of

Reproductive

Tract

Infections

/

Sexually

Transmitted

Health education for prevention of RTI/ STIs; Treatment of RTI/ STIs.

Nutrition Services: • Diagnosis of and nutrition advice to malnourished children, pregnant women and others. Diagnosis and management of anaemia, and vitamin A deficiency. Coordination with ICDS.

• •

School Health: Regular check ups, appropriate treatment including deworming, referral and follow-ups. Adolescent Health Care: Life style education, counseling, appropriate treatment. Promotion of Safe Drinking Water and Basic Sanitation Prevention and control of locally endemic diseases like malaria, Kalaazar, Japanese Encephalitis, etc. Referral Services: Appropriate and prompt referral of cases needing specialist care including: • • • Stabilization of patient Appropriate support for patient during transport Providing transport facilities either by PHC vehicle or other available referral transport.

Training: • Health workers and traditional birth attendants • Initial and periodic Training of paramedics in treatment of minor ailments

• • •

Training of ASHAs Periodic training of Doctors through Continuing Medical Education, conferences, skill development training, etc. on emergency obstetric care Training of ANM and LHV in antenatal care and skilled birth attendance.

STEPS IN THE PROCESS OF ENHANCING THE CAPABILITIES OF THE PHC The first step is to furbish the PHCs (land, building, equipment, and supplies) which will be set up by us. We anticipate each PHC to consist of an initial screening room with a computer, an examination room for the doctor, a laboratory for medical tests and supplies, and toilets. The furnishing will be simple, comfortable, and durable. The most critical infrastructure element is electricity. We propose to use either solar panels or diesel generators (depending on a cost-benefit analysis) connected to batteries for uninterrupted electric power for computers and laboratory equipment. Such units will assure the operation of equipment for much of the day even when conventional electric power is unavailable. Each PHC will have a full time staff consisting of a paramedic individual to perform initial screening with the computer, a trained nurse or physicians’ assistant, and a laboratory technician. We anticipate that a qualified medical doctor will be shared between 3-5 PHCs in a given area. Training of this staff in the novel technology and in the holistic approach we are proposing will be extensive and continuous, and their performance will be monitored constantly as described. In addition to the testing capability of the on-site medical laboratory, a crucial tool for diagnosis will be the computer. In addition, based on this diagnosis, it will also prescribe medicines for minor illnesses, which will be sold at cost by the PHC. In cases of probable major illnesses or when the diagnosis is not clear, the computer output will propose a future course of action—further tests and possibly a visit to a specialist. In the latter case, the computer will print out the patient’s relevant/essential history that can be taken to the specialist. We anticipate that the majority of cases will be handled at the level of PHCs, thus drastically cutting down the burden placed on hospitals and doctors. Patients visiting PHCs will also be provided health education by the staff through posters and through audiovisual demonstrations. Providing information and help with family planning, and awareness on communicable diseases, will be a key role of the staff. Community programs for which we shall form collaborations with self NGO and social workers will supplement these activities. At present we envisage each PHC to be an isolated unit. Over a three-year time frame we propose to connect the computers at different PHCs through standard telephone and/or cell phone link to a central coordination/support center. The central facility will then be able to collect and update the data from all PHCs within its jurisdiction, and perform pattern

detection and epidemiological analysis, thereby predicting epidemics and exposing widespread health problems in their early stages. In addition to simplifying the uploading/downloading of data onto the central computer, this enhancement will allow online access to specialists via e-mail, further reducing patient's travel time and cost and the load on urban health care facilities. As a final step, we anticipate enhancing the diagnostic capability of PHCs through video consultations wherein the patient (through the PHC) will access a physician (and even a specialist) via a two-way video camera and screen. We anticipate that this technology and the required transmission rate using cellular connections will become a reality in rural India in 5-10 years.

HEALTH EDUCATION AND DISEASE PREVENTION Rural India faces many very serious problems. Notable amongst them are potable water, emerging pandemics, population control, good hygiene and sanitation practices, basic education, and simple techniques for improving their crops and lives. One cannot expect to upgrade the people’s health without simultaneously making an impact on these issues, and vice versa. We will, therefore, train and empower the staff at the PHCs to spread awareness on some of these issues, build trust within the community, and to take a holistic approach to health care. Using the telephone link to the central facility, relevant training and educational material and specific health instructions will be periodically transmitted to the computers at all PHCs, and the status of various educational programs will be monitored.

COMMUNITY INVOLVEMENT Influences on Patient‘s Health

For the PHCs to be effective, people have to believe that the PHCs are there to serve them and to provide value. To facilitate this we plan to involve the local population in the

operation and in the community outreach programs. We also plan to encourage cultural activities, self-help programs, and health education through the PHCs. The monitoring role of us will be to evaluate the performance of PHCs and to provide guidance. Evaluation will be based on one simple criterion — whether the PHCs have significantly improved the health and well being of the community.

SUPPORT AND TRAINING CENTERS Ongoing Support and Training of PHC personnel are the responsibility of the Support and Training Centers established for PHCs. Support activities consist of recruiting PHC staff, set-up of facilities, supply of medicine, maintenance/repair of hardware, coordination of transportation, interaction with local community, etc. Field coordinators and computer technicians carry out most of these activities. Arrangements with doctors and hospitals/clinics in the nearby areas will be made for handling referrals from PHCs. Involvement of local NGOs and volunteers will be encouraged. Support activities will be coordinated and made efficient through on-line communications, tracking procedures/systems, pre-maintenance, periodic status review meetings, and other techniques. The goal is to ensure that PHCs are fully operational at all times to serve the community. Training of PHC staff covers the following areas: a) administration of PHCs, b) conducting laboratory tests, c) proper understanding of the cultural and social norms of the area, and d) how to carry out health education. Comprehensive training for the above will be conducted at the Support and Training Centers, which will be followed by on-site training at the PHCs under the supervision of physicians and field coordinators. Training materials and User Guides will be supplied. One of the most important aspects of the training will be the communication skill of the staff. In additional to English, they will need to be fluent in the language of the community they serve. Since gaining the trust of the community is the foundation stone of our approach, we feel that communication skills are very important. Using the feedback we receive from the PHCs, illustrative examples of good communication with patients and the community will be developed in an audiovisual format, and will be included in the training. Training to provide health education will be an integral part of the program. The initial scope of this program and the current status in the development of the primary health facilities in the villages. We will supplement this by initiating an active program to attract visiting physicians, social scientists, and public health officials. Their recommendations will be incorporated where appropriate, and additional training and educational materials will be developed with their assistance.

Health Education and Community Activities Initially we shall concentrate on the following community health education related activities: Training of local women as midwives to reduce risks during childbirth. • Instruct women on pre and post-natal care and early childhood development. • Provide information on family planning and birth control. Give instructions on simple practices that improve hygiene and sanitation. Provide instructions on how to make drinking water safe. Provide information on how to reduce the risk of communicable diseases. •

• • •

An educational course on health and hygiene, emerging pandemics (TB, malaria, Hepatitis B, Hepatitis C, sexually transmitted diseases, and HIV), addictions (alcohol, tobacco, drugs), abuses (emotional, physical, sexual), and environmental concerns (air and water pollution) has already been developed in Microsoft PowerPoint. At present this material is information rich and in the form of brief summary statements -- an information resource organized by topics. Over time we propose to convert this into a modular multimedia format. The modularity aspect is crucial as we envisage maintaining a central backbone that is relatively stable and examples illustrating the points to be drawn using local people and situations. Offering health education and learning how to communicate the message in a simple manner will be an integral part of the training for the entire staff. It will be available at each PHC so that the staff can refresh their understanding as needed. A second important way in which we propose to deliver these instructions is to develop homegrown video demonstrations. These will be recorded using local people who hold the respect of the communities, and using local situations to provide better identification with the problems and the solutions. These videos will be duplicated for distribution and the local PHC staff will be trained to further explain and demonstrate the procedures so as to make their adoption easier. Instructions will also be offered to the community at the time of visit to the PHCs. We plan to use the computer at the PHCs and possibly a television with a video player to continually provide this information while patients/families wait for their checkup. Local community centers and village meetings are other forums for presenting the information. Local community and social workers will be provided the necessary tools, like the homegrown videos, to enable them to educate the rural population on health issues. The field coordinators will organize the above activities with the chief functionary, project coordinator, skilled resource persons and community leaders.

APART FROM THE ABOVE, OUR ORGANIZATION WILL PROVIDE THE FOLLOWING FACILITIES AT THE PHC AS PER STANDARED SET OUT IN THIS REGARD: BASIC LABORATORY AND DIAGNOSTIC SERVICES:

I.

Essential Laboratory services including i. ii. iii. iv. v. vi. vii. viii. ix. x. xi. Routine urine, stool and blood tests (Hb%, platelets count, total RBC, WBC, bleeding and clotting time). Diagnosis of RTI/STDs with wet mounting, Gramsstain, etc. Sputum testing for mycobacterium (as per guidelines of RNTCP). Blood smear examination malarial. Blood for grouping and Rh typing. RDK for Pf malaria in endemic districts. Rapid tests for pregnancy. RPR test for Syphilis/YAWS surveillance (endemic districts). Rapid test kit for fecal contamination of water. Estimation of chlorine level of water using orthotoludine reagent. Blood Sugar.

II. III. IV. V. VI. VII. VIII. IX. X. XI. XII. XIII.

Selected Surgical Procedures Functional Linkages with Sub-Centres Record of Vital Events and Reporting General store Environment friendly features Other amenities Computer Equipment and Furniture Manpower Ambulance and Transport for Supervisory and Other Outreach Activities Drugs Other required facilities to be provided to the patients of particular case.

For HUMAN LIFE SOCIETY

(Amarendra Singh) President