Government of Andhra Pradesh

STRENGTHENING OF COMMUNITY
HEALTH & NUTRITION CLUSTERS

Senior Public Health Ofcers

REFERENCE GUIDE

COMMISSIONER OF HEALTH AND FAMILY WELFARE

ANDHRA PRADESH, HYDERABAD
 index
S.No. TOPICS Page No

I Introduction 1-3
II The Senior Public Health Officers (SPHOs) 4-10
III Role of SPHOs in Various Programmes 11
a) Implementation of JSY 12
b) Implementation of JSSK 13
c) ASHA Programme 14-16
d) Child Health 17-18
e) Routine Immunization Services 19-21
f) Implementation of IDSP 22-23
g) National Vector Borne Disease Control Programme 24
h) RBSK 25
I) RKSK 26-27
j) RNTCP 28-30
k) NCD 31
l) NLEP 32-33
m) NPCB 34
n) HMIS & MCTS 35-37
o) 104 Services & 108 Services 38
AP Civil Services (Conduct) Rules 39-42
IV AP Civil Services (CCA) Rules
V Right To Information Act 43-45
Indian Public Health Standards (IPHS) for Primary 46-58
VI
Health Centres (PHCs)

VII Services to be Provided in a Sub-Centre (IPHS) 59-71

 INTRODUCTION

The Government of Andhra Pradesh has been making sustained efforts to provide quality health care
to its citizens with special attention to those living in remote and interior areas and those belonging to the
under privileged and disadvantaged community of the society. In this direction, the Government has been
implementing the National Health Mission (NHM), along with several other schemes, programmes and
activities with the aim of achieving the MDGs by making the health care delivery system effective and
responsive to the needs of the community.
To strengthen the capacity of the health care delivery system for effective prevention and efcient
management of both Communicable and Non communicable diseases, provision of comprehensive
RMNCH +A services, and strengthening of referral system and improving the standards of quality of care on
par with Indian Public Health Standards (IPHS) .
To improve effective monitoring, coordination and support to the PHCs and the sub-centres and to
strengthen the referral system especially among the primary level and secondary level health systems the
process of primary Health institutions' rationalization, the Government has established two hundred and
twenty ve (225) community Health and Nutrition Clusters (CHNCs) across the state with a view to provide
comprehensive health services to population ranging from one to three lakhs through a network to proximate
PHCs and Referral hospitals - CHC/ Area Hospital/District Hospital / Teaching Hospital and also Community
Health and Nutrition Cluster ofce (CHNCO) was established in the CHC headquarters with responsibilities
for supervision, monitoring and coordination of all the health activities like health prevention, promotion,
treatment and referral services of all health institutions within the CHNC area, in the premises of the CHC.
The Government of Andhra Pradesh decided to organize primary health care delivery to the rural areas
through Community Health and Nutrition Clusters (CHNCs), a senior public Health Ofcer to head these
clusters and supported by other staff.

THE CHNCs WERE CREATED TO ACHIEVE THE FOLLOWING OBJECTIVES

1. Strengthen preventive, promotive, curative and referral health services through rational
deployment of human, material and infrastructure resources available within the CHNC area.

2. Strengthen rst referral units (FRUs) - CHCs and Area Hospitals and provide them with
comprehensive emergency obstetric and neonatal care service facility (CEmONC).

3. Strengthen the Primary Health Centres by ensuring their function round the clock throughout the
year by providing additional human resources, infrastructure etc.

4. Strengthen the referral system i.e., the linkage between the village, sub-centre, PHC,
CHC/AH/District Hospitals/Teaching hospitals.

5. Establish an effective planning, coordination, facilitation and monitoring system for a cluster of four
to ten PHCs.

6. Strengthen community outreach through xed day visit to sub-centres and villages by the medical
and para-medical staff.

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STAFF POSITION AT THE CHNC
CHNC Head Quarter staff
1. Senior Public Health Ofcer (SPHO)
2. Community Health Ofcer (CHO)
3. Deputy Paramedical Ofcer (DPMO)
4. Health Educator (HE)
5. MPHEO/ sub unit ofcer (Malaria)
6. Para Medical Ophthalmic Ofcer (PMOO)
7. Senior Assistant
8. LD computer/ Data Entry Operator (DEO)
THE KEY FUNCTIONS OF CHNC INCLUDE THE FOLLOWING
a) Supervision and monitoring of all the sub-centres and PHCs within the CHNC service area and
exercise day-to-day administrative control and supervision over the staff of Health, Medical and
Family Welfare department within the CHNC jurisdiction.
b) Planning, implementation supervision, co-ordination, trouble-shooting, innovation and monitoring
of all activities that would contribute to improve maternal and child health and nutrition, disease
prevention, health promotion, effective management of illness and referral of complicated cases.

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c) Effective implementation of xed-day health services, integrated village health and nutrition day
interventions, all activities under the National Health Mission (NHM), National disease control
programmes, emergency transport system, RBSK, private clinical establishment regulation act and
other public health enactments and programmes and activities of the Medical, Health and Family
Welfare Department.

d) Close supervision of the health and nutrition interventions in the service area of the CHNC through not
less than fteen days of eld visits by all CHNC functionaries.

e) Ensuring effective functioning of the sub-centres and primary health centres through supportive
supervision, facilitatory guidance and capacity development, especially ensuring xed day health and
nutrition services in the villages by the ANM, PHC Medical Ofcer and other eld staff. Comprehensive
ante-natal, intra-natal, and postnatal care services, tracking of pregnant and lactating mothers and
children, cent per cent institutional deliveries by skilled birth attendance integrated management of
neonatal and childhood illness, immunization, growth monitoring and nutrition support and
rehabilitation, village health and sanitation, water and food quality monitoring etc.

f) Facilitate close collaboration and coordination with the Rural Development, Women and Child Welfare
Development, Rural Water Supply, Panchayat Raj, and School Education Departments.

g) Sustained capacity development of all functionaries of the health system through supportive
supervision and facilitatory guidance, apart from structured training inputs and hands-on practical
training at hospitals and health facilities.

h) Continuous information-education-communication and behavioral change communication (IEC and

BCC) efforts and constant innovation in all activities and increased responsiveness and decentralized
decision making process.

I) Close coordination with the referral hospital and ensure seamless referral of patients from the sub-
centre and PHC to the referral hospitals and ensuring CEMONC and SNCU services to all the citizens.

j) Monitoring and reporting of all health and nutrition activities in the CHNC service area and any other
duties assigned by the Government from time to time.

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 THE SENIOR PUBLIC HEALTH OFFICER (SPHO)

Senior Public Health Ofcer is the in charge of the CHNC and supervises the overall functions of PHCs &
Sub-Centers which are placed under administrative control of CHNC and ensures that
 All the State and National public health programs are implemented successfully in the CHNC
jurisdiction.
 Quick and effective response during epidemics and disasters through primary health centers in the
jurisdiction of CHNC.
 He/she shall work under the administrative control of the District Medical and Health Ofcer.

 All sub-center staff shall report to the PHC Medical ofcer, and the medical ofcers of the PHCs in
CHNC area shall report to the DM&HO through SPHO only.

Sub Centre PHC CCHNC DM & HO

 All the CHNC HQ staff will be under administrative control of SPHO and report to the SPHO directly.

 He / she may assign any job to any health functionality in his team, which is deemed essential in
achieving Public Health goals.
 By virtue of his/her designation, it is implied that he/she will be solely responsible for the proper
monitoring & functioning of the PHCs & Sub centers in his/her CHNC area and ensuring the
achievement of expected level of performance of PHCs in his jurisdiction.
 He will ensure the preparation of the monthly progress report of the CHNC by his supportive staff
namely CHO, PHN, DPMO, LD COMPUTER/DEO, and Senior Assistant and personally nalize that
is generated for onward transmission.
ADMINISTRATIVE FUNCTIONS OF THE SPHO & DDO OF CHNC
1. The SPHO will ensure that the Village, Sub center and PHC wise health action plans are prepared with
focus on special health problems specic to the CHNC area.
2. The SPHO will supervise the work of the supportive staff directly working at CHNC ofce under him
and PHCs in the CHNC.
3. The SPHO will ensure general cleanliness inside and outside the premises of the SPHOs ofce and
also maintenance of the ofce equipment under his charge.
4. The SPHO will ensure that the staff in whose custody the inventory and stock registers are kept is up-
dated regularly and all the stores and equipment supplied to the CHNC ofce are well accounted
properly by periodic stock verication of stores, equipment, placed at CHNC & PHCs.
5. The SPHO will get indents prepared timely for drugs, instruments, linen, vaccines, ORS and
contraceptives etc from PHCs sufciently well in advance and will submit them to the appropriate
higher health authorities.
6. The SPHO will ensure the proper maintenance of the vehicle allotted to the CHNC and its logbook.

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 7. The SPHO will scrutinize the Advanced tour programs of his eld supervisory staff and suggest
changes if necessary to suit the priority of work.
8. The SPHO will scrutinize the Advanced tour programs of PHC medical ofcers, PHC eld supervisory
staff and suggest changes if necessary to suit the priority of work.
9. The SPHO will ensure that the following Charts and information is displayed in his room.
a. The CHNC area map showing geographical area, location of PHCs sub centers and
habitations covered by the sub centers and the PHC and CHNC duly depicting the population
and distances.
b. Program wise performance display charts of CHNC.
c. Demographic data display charts of CHNC, PHCs & citizens charter.
d. Charts displaying morbidity and mortality health statistics of CHNC.
e. Other important information specic to the area covered by his PHCs in CHNC.
f. SPHO will be Public information ofcer (Right to information act) for CHNC and senior assistant
will be APIO of CHNC.
10. The SPHO will conduct monthly review meetings with M.Os of the PHCs in his area of jurisdiction and
evaluate the progress of work and suggest steps to be taken for further improvements to provide
better health services.
11. He will have supportive supervision over PHCs. He/She will encourage supportive supervision by the
supervisory staff of CHNC and PHC.
12. The SPHO will supervise and ensure that
a. PHCs will prepare indents for drugs and send to the DM&HOs ofce and APSMIDC based on
monthly I.P, O.P data of PHCs for submission to central drug stores.
b. Ensure that IEC material, medicines and kits are supplied to the Sub Centres, ASHAs etc &
ensure that the display of such material in villages and sub-centers.
c. The disbursement of the honorarium to ASHAs and other link workers regularly through Medical
Ofcer of PHC & MPHA(f) as per program guidelines.
13. The SPHO will periodically verify and ensure the maintenance of the prescribed records at PHC
level, under FW, NHM, Malaria, TB, Leprosy, VS and other programs. He/she will give technical
advice and corrective guidance to the PHC staff for proper maintenance of these registers.
14. The SPHO will receive reports from the PHCs through the Medical Ofcers of the PHCs and their
supervisory staff. He gets them compiled and submits them regularly to the District Health
Authorities and he will also cross check the reports in random before the next review meeting and
share his observations to take corrective action.
15. The SPHO will keep notes of his visits to the area and submit every month his tour report to the
DM&HO.
16. The SPHO will discharge all the nancial duties entrusted to him and ensure that the senior assistant
of his own ofce maintains all the nancial records and accounts are reconciled every month. (Refer
Hand book on Ofce and nancial management).

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 17. The SPHO will ensure that the senior assistant will maintain all the standard ofce records for day-to-
day administration. (Refer Hand book on ofce and nancial management.)
18. The SPHO will submit any information / reports / documents to the DM&HO, District Collector,
Director of Health, Secretary HM&FW monthly and as and when called for such as position of cadre's
strength against sanctioned posts & monthly DORs SOEs / UCs for the funds released to all PHCs
under all schemes including central and state budget and replies to relevant audit paras of CHNCs
and PHCs.
20. The SPHO will exercise every delegated authority and execute the orders of DM&HO, DH,
Commissioner of PHFW, Secretary HM&FW.
21. The SPHO will inspect registered private hospitals and nursing homes and submit the reports on all
communicable diseases, surgeries, implementation status of PC-PNDT act and other related
services of private nursing homes and hospitals in his jurisdiction.
SUPPORTIVE SUPERVISION BY SPHO
The SPHO ensures that PHC Medical Ofcers and staff under his administrative control reach out to the
community and provide integrated – RMNCH+A, disease prevention (CD & NCD) and management, health
promotion services.
The SPHO should effectively utilize the services of all the headquarter staff, PHC Medical ofcers and
all eld staff. He / She will ensure that the Medical Ofcers of PHCs visit each and every village in the service
area of each sub center once in a month.
The work of the SPHO is classied as follows.
I. Supportive Supervision of Curative Work.
II. Supportive Supervision of Preventive and Promotive Work.
III. Supportive Supervision and Ensuring the Effective Delivery Package of Services Under Various
National Health Programs through PHCs.
SUPPORTIVE SUPERVISION OF CURATIVE WORK IN THE PHCS IN CHNC
1. He / She will ensure that the medical ofcers of the Primary Health Centre & their supervisory staff
prepare the annual health action plan for the village, sub center, primary health centre wise.
2. The SPHO will receive and keeps a copy of every GO Letters, memos, circulars, orders any related
administrative documents and circulate them to every PHC in his jurisdiction.
3. He / She will periodically visit PHC s and ensure that the Medical Ofcer will organize the out-patient
department, inpatient services, laboratory, stores as per standard guidelines and will allot duties to the
ancillary staff to ensure smooth running of the O.P, I.P department.
4. He/She will periodically visit PHCs and ensure that the MOs will make suitable arrangements and
distribute the work to the staff for the treatment of emergency cases which come outside the normal
O.P. Hours.
5. He/She will periodically visit PHCs and ensure that the laboratory services properly organized for
patients for proper diagnosis of the disease where ever necessary and within the scope of PHC
laboratory.

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6. He/She will periodically visit PHC s and ensure that the Medical Ofcer will cooperate and coordinate
with other institutions like CHC, Area hospital for providing medical care services in his area and refer
appropriate cases to these institutions for further care.
7. He/She will periodically visit PHCs and ensure that the MOs will visit each sub- centre in his area at least
once in a fortnight on a xed day not only to check the work of the staff but also to provide support to
curative services.
8. SPHO will conduct annual verication of drug stores, inventory of equipment and furniture of CHNC &
PHCs and submit a report to the DM&HO.
9. SPHO will coordinate and ensure convergence of related functions with Rural Water Supply,
Panchayath raj, Women development and Child welfare department, Revenue department, Police
department, re and disaster management establishments, Non government Organizations, social
welfare, tribal welfare departments, Education department.
10. SPHO will ensure that proper biomedical waste management at PHCs in his jurisdiction.
11. SPHO shall attend and advise where ever a senior ofcer's intervention is required at HDS meetings of
PHC s in his jurisdiction.

SUPPORTIVE SUPERVISION OF PREVENTIVE AND PROMOTIVE WORK

1. He/She will periodically visit PHCs and ensure that the PHC Medical Ofcer and all the members of his
Health Team are fully conversant with the various National Health & Family Welfare Programs to be
implemented in their area allotted to each health functionary.
2. He/She will periodically visit PHC s and ensure that the PHC Medial ofcer will assess quality and
reliability of the work at sub centers periodically both in the clinics and in the community setting to give
them the necessary guidance and direction.
3. He/She will ensure that the MOs of PHCs will prepare operational plans and ensure effective
implementation of the same to achieve the laid-down targets under different National Health Family
Welfare Programs.
4. He/She will ensure that the MOs of PHCs will keep close liaison with MandaI development ofcers and
his staff, community leaders and various social welfare agencies in their areas and involve them to the
best advantage in the promotion of health programs.
5. He/She along with the MOs of PHCs will conduct eld investigation to delineate local health problems
for planning, changes in Health strategy for effective delivery of Health and FW services.
6. He/She will ensure that the Medical Ofcer will ensure the regular conduction of IEC programs at
habitation level.
7. He/She shall conduct enquiries on administrative, service, nancial, service delivery matters on
instructions of District medical and health ofcer / State administration.

HOW EXACTLY TO SUPERVISE AND MENTOR…..

The purpose of supervision is to guide, support and assist staff to perform well in carrying out their
assigned tasks. Supportive supervision is a process of helping staff to improve their own work performance
continuously. It is carried out in a respectful and non-authoritarian way with a focus on using supervisory
visits as an opportunity to improve knowledge and skills of the health staff.

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FUNCTIONS OF A SUPERVISOR
Supervisors at every level and in all parts of an organization have a number of basic functions. These
include:
1. Setting individual performance objectives (the activities an employee should accomplish by a certain
date) with the employees themselves so that they know what is expected of them.
2. Managing any performance problems and conicts that arise and motivating and encouraging
employees to do their best work.
3. Having regular contact with staff members through supervisory sessions to motivate and provide
feedback, solve problems and provide them with guidance, assistance and support.
4. Designing a supervisory system, including a supervisory session plan with selected items to supervise
during each session.
5. Preparing a supervisory schedule of upcoming supervisory sessions which shows the date and time of
each session and lists any content that can already be foreseen. This should be updated periodically.
6. Conducting periodic performance appraisals to review an employee's past performance in order to
make sure performance objectives are being met.
THE STYLE OF SUPERVISION!!!
 There are many different styles of supervision, but all supervision is made up of two basic components
giving direction and providing support.
 Giving direction involves one-way communication in which the supervisor tells the employees what to
do and when, as well as where and how the tasks are to be accomplished.
 Supervisors provide support through their relationships with their employees. This implies more of a
two way communication in which supervisors encourage and guide the staff, discuss any questions or
difculties and enable them to carry out their jobs effectively (task oriented or relationship oriented
supervision) Some employees work best independently, needing direction but little support, other
employees work better with a signicant amount of support from their supervisor.
 Supervisors can maintain a helpful, cooperative, positive atmosphere by examining their own
behavior toward their employees.
WAYS TO IMPROVE THE WORK ENVIRONMENT FOR THOSE YOU SUPERVISE
Make sure that you DO
 Give sufcient instructions (complete and specic).
 Explain targets, deadlines and dates for activities in advance.
 Admit your own mistakes.
 Support your subordinates.
 Delegate responsibility appropriately.
 Trust your staff members.
 Recognize merit when it is warranted.
 Supply employees with adequate materials, equipment and support.
 Give employees the opportunity to participate and to use their own initiative.
 Deal with problems in an honest and straight forward manner.
 Give the real reasons for problems or decisions.
 Make an attempt to see the employee's point of view.

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MAKE SURE THAT YOU DON'T
 Scold an employee in the presence of others.

 Show favoritism toward certain employees.

 Blame an employee for your own mistakes.

 Intrude in the personal matters of employees.

 Provide excessive supervision by being too vigilant, checking even unimportant details.

 Gossip with one employee about another.

 React negatively to employees' ideas.

EFFECTIVE FEEDBACK FROM A SUPERVISOR TO A STAFF

"During the visit to Mrs. Ramakka house today, you were very friendly and warm, and I see that you
have established a good relationship with her. Your reminders to her about how to take the pill were clear and
complete, and it is excellent that you remembered to repeat them, since she is a rst-time user who just
started last month. You listened well when she told you the problems she has been having with taking the pill.
"However, there are two things that you should do differently next time you see a client with these
complaints. She is a new pill user, and it is important to reassure new pill users that their nausea will probably
disappear by the second month. Her headaches could be due to many causes. Next time a pill user
complains of headaches, ask her whether she had these headaches before she started taking the pill. Take
her blood pressure. Also, keep track of who is complaining about headaches. If a woman has this complaint
two months in a row, refer her to the health centre. If her headache is severe and accompanied by nausea,
refer her at once.
Later this afternoon, I'll review our policies for treatment of side effects of the pill with you, to refresh you
memory".
INEFFECTIVE FEEDBACK FROM A SUPERVISOR TO A STAFF
"I've been meaning to tell you, I don't like the way you handled the visit to Mrs.Ramakka house last
month. You spent too much time talking about unimportant things. This programme is not an excuse to sit
and chat with your neighbors! She said she'd had them before. You obviously haven't remembered out
training sessions very well. Are you too lazy to re-read the manual? Don't you remember what to do when a
client complains of headaches? Go back and read the manual, and don't let me catch you making that
mistake again.
SUPERVISOR'S SELF-ASSESSMENT CHECKLIST
Did you
1. Set a friendly and positive tone? Don't carry your own problems and anxieties to the people you
supervise.
2. Review problems, areas of concern, and level of knowledge on various topics? You can choose
different topics for each visit.
3. Provide staff with immediate feedback on their performance, emphasizing both their strengths and the
areas that need improvement?

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 4. Ofcer encouragement and appreciation and share information on the work progress?
5. Review a pre-selected topic and perhaps areas of weakness found during observation?
6. Discuss and attempt to solve specic problems facing the staff? You can deal with the urgent
problems immediately. If you don't have enough time to deal with all the problems, leave the least
urgent for the next visit.
7. Check to see if new is needed and whether there are expired items in the inventory?
8. Review records for quality and completeness?
9. Summarize the main conclusions of the visit and schedule the next supervisory visit?
SUPERVISING AND SUPPORTING YOUR STAFF
1. Set specic performance objectives for and with each staff member.
2. Develop a supervisory schedule showing the date and time of supervisory sessions and distribute it
to staff.
3. Develop a supervisory checklist that lists what will be observed, the data to be collected, and
programme support activities for each session.
4. Supervisory sessions, at a minimum, consists of :
a. A review of the activities for the past three to six months.
b. A plan for future activities
c. A discussion of employees concerns.
5. Review the notes of the supervisory sessions immediately following the sessions, write down the
follow-up activities that were promised during the session and carry them out.
6. Handle performance problems in a timely and equitable manner and nd reasonable solutions with
the help of the employees in question.
7. Employee conict resolution techniques and handle conicts in a timely and equitable manner.
8. Pay attention to the quality of the work environment and make - adjustments as needed
9. Use staff motivation techniques.
10. Provide constructive feedback on a regular basis.
11. Conduct scheduled employee performance appraisals, providing employees with the time and
opportunity to comment on the effectiveness of their supervisors.

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 ROLE OF SPHOs IN
VARIOUS PROGRAMMES

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 ROLE OF SPHOs IN IMPLEMENTATION OF JSY

JANANI SURAKSHA YOJANA SCHEME (JSY)

 The Government of India launched Janani Suraksha Yojana (JSY) scheme from April, 2005 onwards.
In Andhra Pradesh it was implemented from 1st November, 2005 onwards with an objective to reduce
Maternal Mortality Rate (MMR) and Infant Mortality Rate (IMR) by promoting institutional deliveries.
 The JSY is a safe motherhood intervention under the NRHM.

 For Rural BPL woman Rs.1000/- (Rs.700/- under JSY (GOI) + Rs.300/- under Sukhibhava (State
scheme) will be paid who delivered in Govt. hospital towards transport and incidental expenses.
 For Urban BPL families Rs.600/- cash assistance will be paid to such eligible pregnant woman of
urban areas who comes to Govt. Hospitals in Urban Areas for delivery Services.
 For Home deliveries Rs.500/- will be paid.

 The pregnant women should register in MCTS with AADHAR & Bank A/c Number, so the payment can
be done through DBT with AADHAR linked.
SPHO ROLE
• Should Monitor the program with PHN.
• The SPHO should check all the institutions for payment of JSY amount to the beneciaries.
• The SPHO should instruct ANMs & ASHAs to sensitise every pregnant woman who comes for ANC
check up on JSY scheme.
• The SPHO should instruct all the ANMs to enter AADHAR details of pregnant women in MCTS at the
time of registration.
• The SPHO should ensure that payment should be made by DBT.
• The SPHO should see that the payment should be done within 48hrs after delivery.
• Identify the gaps for non-payment of JSY and take necessary action accordingly.
• He should cross-check beneciary list with ANMs eld service register.
• They should also monitor the IEC activities on JSY scheme.

SPHOs MONITORING PROFORMA

No. of Payment Action

Total No. Total No. women No. through
Sl. Name of the Taken
Deliveries JSY received received AADHAR Defaulters
No Institution &
conducted beneciaries JSY in 48 hrs or Cheque
Remarks
Amount

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 ROLE OF SPHOs IN IMPLEMENTATION OF JSSK

JANANI SISHU SURAKSHA KARYAKRAM (JSSK)

The Government of India has initiated a new policy to guarantee free & cashless deliveries including
cesarean operations in all public health institutions under JSSK scheme under NRHM without any user
charges and any out of pocket expenditures and accordingly the Government of A.P issued G.O.No.1591
dated 08-09-2011 for implementation of JSSK scheme in Andhra Pradesh and launched the scheme on
22.10.2011. The following are the free entitlements under JSSK scheme for providing deliveries &
cesareans at free of cost and sick new born upto 1 year after birth:
 Free Drugs & Consumables.
 Free Diagnostic Services.
 Free Diet.
 Free Blood.
 Free Transport (through 108 Ambulance from home to institution, institution to referral hospital and
drop back home).
SPHO ROLE:
 PHN will assist SPHO in implementing this program.

 The SPHO should check all the institutions for free entitlements under JSSK scheme.

 The SPHO should instruct ANMs & ASHAs to sensitise on JSSK who comes for ANC check up.

 The SPHO should see that all institutions should maintain drug facility.

 During his visit to the PHC he should verify Total no. of beneciaries for JSSK activity wise i.e., Diet,
Drugs, Blood & Diagnostic.
 Identify the gaps for non-payment of JSSK and take necessary action accordingly.

 The SPHO should take measures to improve drop back facility.

 The SPHO should see that the expenditure should be booked by item wise (Diet, Drugs, Blood &
Diagnostic).
 During his visit to the PHC he should verify.

 Free Drugs & Consumables.

 Free Diagnostic Services.

 Free Diet.

 Free Blood.

 Free Transport (through 108 Ambulance from home to institution, institution to referral hospital and
drop back home).

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 SPHOs ROLE IN ASHA PROGRAMME

The National Rural Health Mission (NRHM) launched in the year 2005, has completed nine years of
implementation. The ASHA programme was introduced as a key component of the community processes
intervention. Over the nine years period, the ASHA programme has emerged as the largest community
health worker programme, and is considered a critical contributor to enabling people's participation in
health.
Guidelines for implementation of the ASHA programme were issued by the Ministry of Health and
Family Welfare (MoHFW) in 2006. The original guidelines were supplemented by several orders issued by
the MOHFW to communicate policy modications to the states. The programme has evolved substantially in
the past nine years.
ROLES & RESPONSIBLITIES OF ASHAs
• ASHA will take steps to creates awareness and provide information to community on Nutrition, Basic
Sanitation, Hygienic practices, Healthy Living & work conditions, Information on existing health
services, Need for timely use for health services.
• ASHA gives services such as ANC, PNC, Immunisation, ICDS, other services provide by
Government.
• Counsel woman and families on birth preparedness, importance on safe delivery, Breast feeding,
Complementary feeding.
• She motivates couples for contraception and permanent methods of family planning, prevention of
common infections including RTI / STI and also care of young children
• She will work with Village Health Sanitation & Nutrition Committee.
• She will escort / accompany pregnant woman and children requiring treatment to the identied health
facility.
• ASHA will full her role through 5 activities
• Home Visits
• Attending the Village Health & Nutrition Day
• Visit to the Health facility
• Holding village level meeting
• Maintaining records
SUPPORTIVE STRUCTURE FOR ASHAs

State Level:
State Nodal Officer /
Management Team

District Level:
District Community
Mobilizer

Block Level:
Block Community
Mobilizer

Sub Block Level:

ASHA Facilitator
one per 20 ASHAs
14
SUPPORT STRUCTURE FOR ASHAS AT PHC LEVEL
• ASHA Facilitator - MPHS (F)
- MPHS (F) is the ASHA facilitator at the PHC level.
- 1 ASHA facilitator per 20 ASHAs.
- She should be supported at village level by ANM, AWW, VHSNC, PRI, SHG, Block Community
Mobilizer & PHC Medical Ofcer.
- She should spend 20 days in eld to provide support to ASHAs in her area.
- ASHA Facilitator should assist block community mobilizer and provide continuous hand
holding support to ASHAs.
ROLES & RESPONSIBILITIES OF ASHA FACILITATOR
• Village visits.
• Conducting cluster meeting of all ASHAs in her area once in a month.
• Attending monthly PHC review meeting.
• Important task of the facilitator is to enable the ASHA to reach the poorest and the most marginalized.
• Support ASHA trainings.
• Facilitating selection of new ASHAs and constitution of VHSNCs.
• Enabling grievance Redressal system for the ASHAs.
• Facilitating community meeting such as VHSNC.
• Check the drug kit and stock record and solve problems related to logistics, Drug kits & replenishment
• Monthly reporting to Block Community Mobilizer on key health indicator.
SUPPORT STRUCTURE FOR ASHAs at Block level
• Block Community Mobilizer (BCM)
- PHN is the Block Community Mobilizer at the Block Level.
ROLES & RESPONSIBILITIES OF BCM:
 Organising Block review meetings every month on a xed day.

 ASHA selection, release of ASHA payments, regular supply distribution and replenishment ASHA kits
and training material.
 To support the District Community Mobilizers for report compilation, planning, and facilitating training
of ASHA Facilitators, ASHA s & VHSNC members.
 Compilation of performance reports according to the formats submitted by ASHA facilitators, to
assess functionality of ASHAs on key tasks.
 Solve issues related to eld level in coordination or conicts if present.

 Maintains a block wise data base of VHSNCs for their training, functionality, expenditure and back
logs is also a regular function.

15
ROLES & RESPONSIBILITIES OF SPHOs FOR ASHAs
• SPHO should arrange monthly review meetings at block head quarter on 1st Tuesday of every month
in co-ordination with Block Community Mobilizer.
• Monitor the work of block community mobilizers and ASHA facilitators.
• Review and assessment of performance of ASHAs.
• Verifying records and release of payments.
• Review and assess functionalities of VHSNC's in term of regular meetings, fund utilizing
• Provide direct support in selection of ASHA, release of payments, replenishment of ASHA kits &
training material.
• Supportive supervision & continuous monitoring – eld visit to assess functionality and hand holding
of ASHA facilitators & ASHAs.
• Verify the work & reports of ASHAs and ASHA facilitators randomly.
• To assess functionality of ASHA on key tasks, identify poor performing ASHAs and to assess the
cause of low performance and devise strategies for improvements.
• Coordinates with district level functionaries.
• In coordination with Block community mobilizer works in compilation of all village health plans made
by VHSNCs and contribute in preparing the community process section of block / district health plan.
• Reviews the data base of VHSNC for the training , functionality, expenditure and back logs.
• Should attend to the grievances of ASHAs and take necessary action.
• To send the ASHA day meeting report and activity based incentive expenditure statement of each
PHC and name-wise ASHA expenditure every month by 15thto the district.
• Ensure Rest rooms for ASHAs should be established at PHCs.

16
 ROLE OF SPHOs IN CHILD HEALTH

The NMR continues to be high in rural and tribal areas specially among SCs / STs. The government has
decided to strengthen neonatal care services in all Health facilities – PHCs, CHCs, AH, DH and teaching
hospitals and to reduce IMR and NMR below 30 per 1000 live births, SNCUs and NRCs are established with
bed strengths of
SNCU in tribal area - 12 beds
SNCU in non-tribal area - 20 beds
NRC in tribal area - 10 beds
NRC in non-tribal area - 20 beds
Atleast one SNCU is functioning in each district Headquarters and Nutrition Rehabilitation Centers
are established in District Hospitals (and/or FRUs), prioritizing tribal and high focus districts with high
prevalence of child malnutrition. The optimum utilization of NRCs must be ensured and encouraged through
identication and referral of Severe Acute Malnutrition cases in the community through convergence with
Anganwadi workers under ICDS scheme.
SERVICES PROVIDED –AT SNCU
a) Care at birth.
b) Resuscitation of asphyxiated newborns.
c) Managing sick newborns (except those requiring mechanical ventilation and major
surgical interventions).
d) Post-natal care.
e) Follow-up of high risk newborns.
f) Immunization services.
g) Referral services
SERVICES PROVIDED- AT NRC
a) 24 hour care and monitoring of the child.
b) Treatment of medical complications.
c) Therapeutic feeding.
d) Providing sensory stimulation and emotional care.
e) Social assessment of the family to identify and address contributing factors.
f) Counseling on appropriate feeding, care and hygiene.
g) Demonstration and practice- by-doing on the preparation of energy dense child foods Using locally
available, culturally acceptable and affordable food items.
h) Follow up of children discharged from the facility.
ROLE OF SPHO
 SPHO should monitor the program with CHO.
 Ensure all the SAM children to be referred to NRCs and also ensure all the mothers of such children get
their nancial assistance for the wage loss during the stay.
 SNCU performance should be given top priority in the reviews as their function plays key role in
reducing IMR and NMR.
 SPHO should create awareness about the functioning and services provided at SNUCs and NRCs
among all the health staff including ASHAs and AWWs.
17
  Stress on the existence and the services provided in the SNCUs for the sick and neonates.
 Referral and admissions of out born sick neonates should be encouraged and monitored.
 All ANMs in the Clusters are to be trained in IMNCI – Integrated Management of Child hood illness.
 ASHA Workers to be trained in Module 6 & 7 (IMNCI) Mother Home Based New born Care.
 Ensure that all ASHA workers will have the ASHA kit.
 The incentives to ASHAs should be paid in time for HBNC (attending to sick newborn).
 All staff must be trained for 2 days in NSSK training package for skills development in providing
Essential new born care.
 Also create awareness to the AWW during the convergence meeting with Women Welfare Child
Development Dept about the facilities available in the SNCU.
 Line listing of low birth weight and newly detected SAM children must be maintained by the ANM and
their follow up must be entrusted to the ASHA.
SPHO SHOULD ENSURE THE FALLOWING TRAININGS IN CHILD HEALTH
a. All Medical Ofcers and Staff Nurses, positioned in FRUs/DH and 24x7 PHCs should be prioritized
for F – IMNCI training so that they can provide care to sick children with diarrhea, pneumonia and
Malnutrition.
b. In order to promote early and exclusive breastfeeding, the counseling of all pregnant and expectant
mothers should be ensured at all delivery points and breastfeeding initiated soon after birth. At least
two health care providers should be trained in 'Lactation Management 'at district Hospitals and FRUs
other MCH staff should be provided 2 days training in IYCF and growth monitoring.
c. Data from SNCU, NBSU, and NRC utilization and Child Health trainings (progress against
committed training load) must be transmitted on a monthly basis to the Child Health Division to the
district and to the State.
d. Infant Young Child Feeding Practices Guidelines launched by GOI to be implemented. Growth
monitoring equipments to be made available at each Health Facility i.e. Sub Center, PHC, District
Hospital. At District Hospitals and high case load facilities RMNCHA counselor to undertake IYCF
counseling after growth monitoring by Staff Nurse / ANM.IYCF trainings for ASHA/ANM/Staff Nurses
to be undertaken.
THE SPHO SHOULD ALSO INSTRUCT ALL THE STAFF ON THE FOLLOWING ISSUES
 In order to reduce the prevalence of anemia among children, between the ages of 6 months to 5 years
must receive Iron and Folic Acid tablets /syrup (as appropriate) as a preventive measure for 100 days in
a year. Accordingly appropriate formulation and logistics must be ensured and proper implementation
and monitoring should be emphasized through tracking of stocks using HMIS.As National Iron Plus
Initiative, IFA syrup is to be administered in biweekly fashion by ASHA , AWW under the supervision of
ANM.
 Use of Zinc should be actively promoted along with use of ORS in cases of Diarrhea in children.
Availability of ORS and Zinc should be ensured at all Sub-Centers and with ASHAs.
 Administration of Vit-A to the children from 6 months to 60 months. Use of Inj Vit-'K' in the labour room
to all the New born Immediately after birth to avoid Vit K deciency bleeding should be stressed.
 Use of Inj Gentamycin to the New born with sepsis.
 The Staff Nurses & Medical Ofcers working in PHCs and CHCs should be aware that the equipment in
the NBSU & NBCCs handled carefully while rendering services to the New Born Care.

18
 ROLE OF SPHOs IN ROUTINE IMMUNIZATION SERVICES
1. Planning
Quality micro plans are essential for reaching global goal of 90% coverage. Revision of microplans
biannually will have better coverage and quality service delivery. Essential components of microplans at
PHC level are
 Maps, basic data, coverage data
 Alternate Vaccine Delivery (AVD) plan & route chart
 List of High Risk areas and monitoring data
 Cold chain contingency plan
 Waste disposal plan
 IEC and social mobilization plan
 Training plan and budget preparation in the standard tool provided by GoI
Desk review of microplans (Sub-Center/PHC) randomly for quality check – integration of session
plan & VHND, missed areas, clear area demarcation of sub-center with two ANMs.
Priority validation of High Risk area/s microplan - mandate. Ensure quarterly identication of
migratory settlements for revision of planning process. Ensure display of MAPs at facility level. Ensure
preparation of CHNC action plan based on SC/PHC microplan.
2. VACCINE PREVENTABLE DISEASE (VPD) SURVEILLANCE
Ensure timely investigation of all reported AFP cases, stool specimen collection and shipment. To
investigate all VPD related outbreaks with support from concerned Medical Ofcer.
3. AEFI SURVEILLANCE
Any AEFI incident needs to be investigated – responsible for lling Preliminary Investigation Report (PIR).
4. MONITORING AND EVALUATION
 Monitor 4 - 6 RI sessions per month in the standard tool provided.
 Survey 60 – 80 houses per month and record the information in the GoI communicated format. Priority
shall be for HRAs, vacant sub-center, recent outbreaks, new service provider and hard to reach areas.
 Monitor and record 2–3 PHCs/CHCs cold chain assessment and stock verication.
 Monitor at-least 3 - 5 VHNDs per month.
 Should visit at-lest 2 sub-centers for supervision.
 Monthly evaluation of HMIS reports and HMIS portal
5. ADVOCACY
 Should organize convergence meeting on RI at cluster level – monthly basis.
 Should prepare joint supervisory action plan on immunization.
 6. RECORDING AND REPORTING
 HMIS reports should be veried & counter signed by SPHO prior to data entry in HMIS software
application.
 Should ensure complete entry of RI monitoring information in the IRIM software and forward
submission to DIO by 5th of every month.
 Analysis of HMIS reports and monitoring data should be done to review the progress on monthly basis.
The analysis should be discussed in Task Force meetings at cluster level for any policy matters. Ensure
reporting of VPD & AEFI cases in the monthly basis. Ensure display of coverage monitoring chart at all
levels. Should ensure proper maintenance all records.

19
 7. OTHER ACTIVITIES (Review meetings / trainings / nancial management)
 Should strengthen review mechanism by organizing review meetings for RI on monthly basis to assess
performance & coverage gaps. RI related trainings should be ensured to all ANMs, MPHS & ASHA /
AWW. Should ensure timely expenditure of budgetary allocations.
 All special drives and awareness camp should be organized.
INFORMATION ON PENTAVALENT VACCINE
What is Haemophilus inuenzae ?
Haemophilus inuenzaeis a Gram-negative coccobacillus that affects only humans. There are six
types of Haemophilus inuenza (a, b, c, d, e, and f), but Haemophilus inuenza type b (Hib) bacteria
accounts for over 90% of serious Haemophilus inuenza infections in children. Hib bacteria live as
commensals in the upper respiratory tract
NOTE: In spite of its name, 'Haemophilus inuenzae' does not cause inuenza (i.e., the “u”) or the
common cold. Similarly, Hib should not be confused with HIV or Human Immunodeciency Virus, the virus
that causes AIDS
MODES OF TRANSMISSION
Like measles, Hib is passed from an infected person to an uninfected person via droplets of
saliva/respiratory secretions, when an infected individual coughs or sneezes. Hib can also be spread when
children share toys and other objects that they have put in their mouth. The probability of transmission
increases when children spend prolonged periods of time together in settings such as day-care or crèches.
Children are often asymptomatic carriers of the Hib bacteria showing no signs or symptoms but still can
infect others.
RISK GROUPS FOR HIB DISEASE
Hib disease is most common in children under ve years of age. Children between the ages of 4 to 18
months of age are most at risk (WHO, 2006). It is important to immunize children and prevent disease very
early in life. At birth, antibodies from the mother sufciently protect most infants. When a child reaches 2 or 3
months of age, the level of maternal antibodies decreases and the risk of Hib infections increases. By the
age 5 years, most children will have already developed their own immunity against Hib. For this reason, Hib
disease after the age of ve years is considered rare.
DISEASES CAUSED BY HIB INFECTION
Bacterial meningitis
Bacterial meningitis is the inammation of the membranes that cover and protect the spinal cord and
brain, known collectively as the meninges. In the absence of vaccination, bacterial meningitis in children is
most often caused by Hib. In developing countries, as many as 40% of Hib cases result in death.
Furthermore, 15% to 35% of children who survive Hib meningitis are left with permanent neurological
disabilities such as mental retardation, developmental delay and hearing loss (NTAGI sub-committee,
2009).
INFLAMMATION OF THE LUNGS
In developing countries, Hib is a major cause of pneumonia (or acute lower respiratory tract infection,
ALRI) in children. Up to 20% of the severe bacterial pneumonia cases are caused by Hib.
OTHER HIB INFECTIONS INCLUDE:
 Septicaemia: Infection of the blood-stream
 Septic arthritis: Infection in the joints
 Osteomyelitis: Infection of the bones
 Epiglottitis: Infection of the larynx and pharynx
In the absence of appropriate and immediate treatment, upto 50% of cases are fatal.

20
DIAGNOSIS OF HIB INFECTION
The diagnosis of Hib disease can be made by bacterial culture, latex agglutination test or by
polymerase chain reaction (PCR). In reality, it is very difcult to identify Hib in resource poor settings. The
bacterial culture of sterile uids like CSF or blood is needed. For CSF, an invasive procedure called a lumbar
puncture (LP) must be done. The samples collected need to be stored and transported, within a short period
of time, in suitable media, while maintaining the appropriate temperature (between 20°C and 35°C) to be
able to culture Hib bacteria.
TREATMENT
Treatment for Hib disease is not always effective because some strains of Hib may be resistant to
antibiotics. Antibiotic resistance is a serious problem, which is continuously increasing in developing
countries, including India. Immunization against Hib is a cost effective strategy of prevention.
STORAGE TEMPERATURE
Pentavalent vaccine should be stored at temperature of 2-8 degree Celsius, in the basket of Ice-Lined
Refrigerator (ILR) and should never be frozen. Conditioned ice packs should be used during transportation
to prevent freezing.
AGE GROUP FOR VACCINATION
Hib containing pentavalent vaccine in India is recommended for infants from 6 weeks to less than 1
year of age.
VACCINATION SCHEDULE AND 'PHASING IN'
Three dose primary series will be considered routine. The rst dose is given to children at six weeks of
age or older. The vaccine to be given at the same time as DPT, OPV, and HepB vaccines, as shown, for
example, in the schedule below.

ADVERSE EVENTS FOLLOWING IMMUNIZATION

Hib vaccine has not been associated with any serious adverse effects. However, redness, swelling
and pain at the site of injection may occur in as many as 25% of those who have been vaccinated. Such
reactions usually start within 1 day after immunization and last for 1–3 days (WHO 2009, Govt. of India,
2010). Less commonly, children may develop fever or can become irritable for a short period. When the Hib
vaccine is given at the same time (or as a combination vaccine with DPT i.e.pentavalent vaccine), the rate of
adverse events following immunization (AEFI) is not any higher than when DPT vaccine is given alone.
However, the introduction of pentavalent vaccine (or any other new vaccine) may coincide with the
increased reporting of AEFIs in the states and districts. All these AEFI cases, including those following
pentavalent vaccine should be reported as per the Government of India AEFI surveillance and response
operational guidelines (Govt. of India, 2010).

21
 ROLE OF SPHOs IN IMPLEMENTATION OF
INTEGRATED DISEASE SURVEILLANCE PROGRAM

The project development objective is to improve the information available to the Government Health
Services and Private Health Care providers on a set of high priority diseases and risk factors, with a view to
improve on the ground responses to such diseases and risk factors.
There are 4 types of Surveillance carried out under IDSP.
1. Syndromic surveillance is based on clinical pattern observed by medical / paramedical personnel and
members of community. This is done at all Sub Centers based on the OP attendance at Sub centers as
well as the entries in eld Registers carried by the Health Workers in to the eld when they visit the
villages. The Syndromic surveillance data is collected in Form S every week.
2. Presumptive surveillance is based on the “Provisional Diagnosis” made on the basis of typical history
and clinical examination by Medical Ofcers at the Outpatient wards in PHC / CHC / Area Hospital /
District Hospital / Medical College (General Hospital) etc. The Presumptive surveillance data is
collected in Form P every week.
3. Conrmed or Laboratory Surveillance is Diagnosis conrmed by an appropriate laboratory test in all
Laboratories at PHC level and above. The Laboratory surveillance data is collected in Form L every
week.
4. Outbreak Surveillance is based on the reports sent by the PHC Medical Ofcer and Investigation
reports by the District Epidemic Investigation Team (DEIT) for each and every occurrence of any
Outbreak. For each such occurrence, the Medical Ofcer has to submit the information in Form C.
Based on the Form C, the District Surveillance Unit (DSU) will report the Outbreak in the IDSP portal.
A surveillance week under IDSP is from Monday to Sunday. All the data reported in the Forms S,P,L
are to be entered in to the IDSP portal http://idsp.nic.in every week. The data entry is done at DSU level till
August 2014. Now as per the Government orders, the data entry has to be done by the Data Managers
identied at all PHCs since September 2014.
During the initial months of pentavalent vaccine introduction, only those children who are coming for
the rst dose of DPT will be administered pentavalent vaccine. Infants who have already received either
their rst or second doses of DPT &Hep B (i.e., DPT1/HepB 1 or DPT2/HepB 2) will complete the schedule
with DPT &HepB only. This is called 'Phasing in' of pentavalent vaccine in UIP.
DOSAGE AND ROUTE
The dose of pentavalent vaccine is 0.5 ml. The route of administration of pentavalent vaccine is the
same as DPTvaccine. This is a liquid vaccine therefore, is used directly from the vial and given by
intramuscular injection in the antero-lateral aspect of the mid-thigh in infants.
NOTE: Children will continue to receive DPT boosters at the age of 16-24 months and 5-6 years of age using
DPT vaccine. Similarly, birth dose of HepB using single antigen HepB vaccine will continue and must be
provided within 24 hours of birth.
INTER-CHANGEABILITY OF THE VACCINES MANUFACTURERS
Liquid pentavalent vaccines (LPV) from different manufacturers can be used to complete the
immunization schedule of an infant.

22
THE ROLE OF SPHO
Should Monitor the Program with MPHEO/SUO
The SPHO has to ensure the following in all the institutions under his jurisdiction
1. Availability of Case denitions for Medical Ofcers in Outpatients wards
2. Writing the “Provisional Diagnosis” by all Clinicians in OP Registers /OP Chits in legible manner is to
be made Mandatory
3. The Pharmacists to consolidate the disease wise data from the OP Registers in the Tally sheets and
ll Form P
4. Medical Ofcers to check consolidation of P Form done by Pharmacist before signing
5. Lab Technicians to ll the Form L based on the samples tested and Positive cases noted in the Lab
Register
6. Lab Technicians to note full address of patients for positive cases
7. Sensitize ANMs in registering symptoms under Form S properly while in the eld
8. MPHS to randomly check S Form with the entries in Field Register
9. The Data Manager identied at PHC to enter the Form S of all Sub Centers under the PHC, the
P Form and L Form generated at PHC
10. Instruct all PHCs to maintain Disease burden charts
11. Instruct all Medical Ofcers to check for raising trends using IDSP portal
12. To monitor the Timeliness & Completeness of reporting every week using the “Time based
Submission status” under “STATUS/ SUMMARY REPORTS” Group
13. Check the consistency of reporting every month for Forms S,P,L. This report can be checked using
the “Consistency reports of reporting units” link under “CONSISTENCY REPORT” GROUP
14. Check the trends of diseases for the last 4 weeks. The data for Malaria, Dengue, Chikungunya, and
Typhoid in Form L and for ADD in Form P are to be specically checked as the same are going to be
closely monitored by the Government. This report can be checked using the “Cases of Selected
Diseases for Selected Period (National/State/District)” link under “SURVEILLANCE REPORTS”
GROUP. It is to be ensured that the cases reported for Vector Borne diseases are same under IDSP
and NVBDCP as the cases entered in IDSP portal are taken to be nal.
15. In case of any Outbreak Occurrence, the SPHO has to monitor the situation using
“Competency Assessment tool for Outbreak Investigation”. The SPHO has to be aware of and utilize
the services of District Priority Labs & Referral Lab Network under IDSP to get the samples tested
and get the results at the earliest.

FINANCIAL IMPLICATIONS:
No nancial implications involved other than the Printing / Making copies of “Tally sheets” for Form P (52
sheets for 52 weeks in a year) at PHC level which would cost less than Rs. 100 /- and may be met from
contingency / HDS funds.

23
 ROLE OF SPHOs IN NATIONAL VECTOR
BORNE DISEASE CONTROL PROGRAMME
OBJECTIVES
 Programme is supervised along with MPHEO/SUO

 Reduction of Malaria and other VBDs by 50%

 Maintenance of ABER over 10% by active & passive surveillance

 Reduction of API to 1.3 or less

 Reduction of case fatality and frequency of outbreaks of Dengue, JE, and Chikungunya

 Elimination of Lymphatic Filariasis by 2015

STRATEGIES
1. Verication of Malaria case detection and surveillance mechanism so as to achieve >10 ABER
2. Review the performance of Labs of PHCs, CHCs, Sentinel Surveillance Hospitals for Malaria,
Dengue/Chikungunya, and JE.
3. Ensuring of Radical Treatment to all reported cases of Malaria by eld staff
4. Estimation & Replenishment of all drugs, lab and eld materials
5. Sensitization of Medical Ofcers and other Supporting staff on NVBDCP regularly
6. Investigation of all suspected death cases of Malaria and other Viral fevers along with MO and
Assistant Malaria Ofcer.
7. Prompt Monitoring and Evaluation of all Epidemics and Outbreaks and containment measures
8. Ensuring of Japanese Encephalitis Immunization where ever conducting
9. Ensuring of single dose of administration of DEC and Albendazole tablets under MDA programme
10. Organization of Morbidity Management Clinics and Hydrocelectomy camps as per NVBDCP
guidelines
11. Ensuring of regular rounds of IRS as per schedule Approved by DPHFW
12. Ensuring of Prompt Vector Control Operations as and when VBD cases reported
13. Ensuring of regular payment of incentives to ASHAs under NVBDCP guidelines.
14. Conducting of convergence meetings with other Departments at cluster level at regular intervals
15. Prompt monitoring of reporting formats of M1 at ASHA/MPHA/Health functionary, M2, M3, M4 at Lab
and VC formats at PHC/Cluster

24
 ROLE OF SENIOR PUBLIC HEALTH OFFICER IN RBSK

One new initiative RBSK has been started with aim to screen all the children from 0 to 18 years for four
Ds – Defects at birth, Diseases, Deciencies and Developmental delays including disabilities. The high
burden of these Children ill health contributes signicantly to child mortality, morbidity and out of pocket
expenditure of the poor families. Diagnosed with illness shall receive follow-up including surgeries at tertiary
level, free of cost under National Health Mission. This initiative has been built on the existing school health
programme where children 0 – 5 years of age attending Anganwadi centres will also be screened besides
school children.
TARGET GROUP:
The services aim to cover all children of 0 – 5 age of group in rural areas urban slums, in addition to older
st th
children up to 18 years of age enrolled in class 1 to 12 in Government and Government aided schools.
a) Babies born at public health facilities and home (birth to 6 weeks)
b) Preschool children in rural & urban slums (6 weeks to 5 years)
st th
c) Children enrolled in 1 class to 12 class in Government and Aided schools (5 years to 18 years).
CHNC LEVEL PLAN & ROLE OF SPHO
 On an average, 2 Mobile RBSK Teams shall be established at each CHNC Level for RBSK
Programme and such teams shall function under the administrative control and supervision of the
SPHOs concerned
 The Tour Programme for each Mobile RBSK Team along with the Route Map should be designed by
the SPHO and DPMO of the CHNC along with the MOs of the PHCs under the coverage area of such
MMU
 The RBSK Report for each Mobile RBSK Team shall be prepared at CHNC Level through the RBSK
Software application that shall be rolled out soon. The SPHO shall be responsible for generation of
such report and taking action to rectify the gaps identied.
ACTIVITIES OF SPHO
1 Divide the Cluster into 2 equal halves geographically
2. The schedule of visits of the Mobile Teams should be communicated to the school, Anganwadi
Centers, ASHAs, relevant authorities, students, parents and Local Government well in advance so
that required preparations can be made.
3. Bi annual coverage of target group with 120 children per day per team for 5 days in a week.
4. Ensure route map is available at PHC/Mandal and Cluster level
5. Cases referred to DEIC
6. Follow up of the cases referred
7. Health facility wise data review to estimate the incidence and prevalence of health conditions and
support them in establishing data base of children screened and diagnosed with specic disease,
disorders and disabilities that require long term follow up and treatment.
1. School Health Day: Health Education EveryThursday Swasthya Lahari
2. School Referral Day: Every Tuesday Referral management
3. Supervise the Programme with DPMO
25
 ROLE OF SENIOR PUBLIC HEALTH OFFICER IN RKSK
DPMO will play a key role in collecting data in time, quality check, analyze and timely reporting in the
following RKSK programmes to SPHO.
a) Coverage of target group as per GoI guidelines( adolescents)
b) Target groups: Dedicated programme for 10 to 19 years olds including vulnerable and under served.
c) Sub - groups : Girls & Boys 10-14 ,15-19 years of Rural, urban Un married, married. In school, out of
school from all social groups ,including the vulnerable and under-served
The SPHO will Review on coverage of adolescents from sub-centre wise, PHC wise and send
consolidated report PHC wise to DMHO (Twice in a year)
PEER EDUCATION PROGRAMME
The PE programme aims to ensure that adolescents or young people between the ages of 10-19
years benet from regular and sustained peer education covering nutrition, sexual and reproductive health,
conditions for NCDs, substance abuse, injuries and violence (including GBV) and mental health. This is
eventually expected to improve life skills, knowledge and aptitude of adolescents.
The SPHO will verify whether the peer groups formed as per criteria and Peer Educators selection is
completed as per guidelines. After formation of groups and selection of PEs the SPHO will review the
vacancies yearly twice or whenever it is needed.
Set targets to PEs at the start of the programme as per the indicators.

Strategies Service delivery indicators Means of verication

Peer Education Percentage and number of Peer Educators
programme enrolled against planned
Percentage and numbers of peer educators
Peer Educator
trained (out of to total number of PEs)
MIS reports
Percentage and number of adolescents
State PIP
reached through village based Peer
AFHC MIS
Educators
Training reports
Percentage and number of sessions held by
peer educators against planned
Number of adolescents referred by PE to
AFHC

KEY FEATURES OF THE PE OPERATIONAL FRAMEWORK IN RURAL AREAS INCLUDE:

In every village, it is expected that at least four peer educators i.e. Two male and two female peer
educators willbe selected per village/1000 population/ASHA habitation. To ensure coverage of adolescents
in both schools and out of school, two peer educators (i.e., one male and one female) will be selected to work
with young people in school, and similarly, two peer educators will be selected to work with young people out
of school. States/ districts can vary this norm depending upon the number of adolescents in school/out of
school (drop outs).
EACH MALE AND FEMALE PEER EDUCATOR WILL BE EXPECTED TO:
Form a group of 15-20 boys and girls respectively from their community and conduct weekly one to
two hour participatory sessions using PE kits, which include books detailing a curriculum for PE sessions
and games.
Participate in Adolescent Health Day to inform and educate young people and involve parents.

26
REFER YOUNG PEOPLE TO:
1) AFHCs and/or Adolescent Helpline
2) The Adolescent Health Day for health check-ups.
PE s will constitute Adolescent Health Club at sub-centre level, under the overall guidance of ANM.
These clubs will meet monthly to discuss issues of PEs and get support from ANM
Peer Educators are expected to maintain a diary, including a brief overview of each session and the
number of participants. At the end of each month Peer Educators are to develop a brief composite report of
the number of sessions and average attendance rates.
The PE programme in urban areas will operate in a similar manner as rural areas.
ADOLESCENT FRIENDLY HEALTH CLINICS (AFHCS)
 Establishment of new AFHCs as per demand
 Orientation for counselors
 Monitoring of AFHC clinics and outreach work
 Qualitative Reporting as per formats (enclosed) and with analysis
 Follow up of Referral services
ADOLESCENT HEALTH DAYS
 AHDs will be conducted once in a quarter as per guideline WIFs
 Screening for anemia for all target group
 Prepare and report of requirement of IFA tablets
 Verifying stock entry and distribution
 Identify of the gaps and follow up
 Management of complications
 Qualitative Reporting with Analysis and Follow up Menstrual Hygiene
 Orientation for target group, parents, community and SHGs
 Plan for requirement of napkins
 Qualitative Reporting as per formats
 Follow up
TRAININGS:-
 Get trained on programme implementation
 Planning and implementation of trainings for health staff (ANM, ASHAs), PEER Educators, AWWs,
NGOs, Public , SHG convergence departments and counselors
 SPHOs should monitor the above programmes and report the same to DM&HO Quarterly
 Prepare budgets and obtain necessary approvals and submit SOEs on time

27
 ROLE OF SPHOs IN RNTCP

The Revised National TB Control Program (RNTCP) is a prestigious intervention from the Government
of India for the control of TB in India. Presently the entire country is implementing the program thus bringing
quality diagnostic and treatment services to the needy TB patients.
GOAL OF RNTCP
To decrease mortality and morbidity due to TB and cut chain of transmission of infection until TB ceases
to be a major public health problem
AIM
Early detection and initiation of treatment
OBJECTIVES OF RNTCP
Objective 1: To achieve and maintain at-least 85% cure rate among new sputum positive TB cases
registered.
Objective 2: To achieve and maintain case detection of at least 70% (51 new sputum positive cases per
one lakh population) of the estimated new sputum-positive cases after achieving objective 1.

TREATMENT CATEGORIZATION

New All new patients

Cat I

Previously treated Previously treated smear positive PTB (relapse, failure,

Cat II treatment after default), smear negative PTB and
extra-pulmonary TB

28
MULTI DRUG RESISTANCE (TB)

Treatment for MDR TB is being implemented in the state in a phased manner from October, 2008 and
covered entire state.

TB NOTIFICATION

The Government of India has issued an order making TB notication mandatory. As per the TB
Notication orders, all health care providers (clinical establishments run or managed by Government
including local authorities, private or NGO sectors and/or individual practitioners) in all the districts and
towns in the State should immediately notify about the TB cases to the local district level nodal ofcial.

BAN ON SEROLOGICAL TESTS

The serological test for TB is widely used in the private sector, even though they are known to be
inaccurate, inconsistent and with no clinical value for TB diagnosis. The World Health Organization (WHO)
in its rst-ever negative policy recommendation recently called on Governments to immediately ban blood
tests prescribed and used to detect TB. The Revised National TB Control Programme (RNTCP) adopted
WHO recommendations.

NIKSHAY

To monitor Revised National Tuberculosis Programme (RNTCP) effectively, a web enabled and case
based monitoring application called NIKSHAY has been developed by National Informatics Centre (NIC).
This is used by health functionaries at various levels across the country in association with Central TB
Division (CTD), Ministry of Health & Family Welfare. NIKSHAY covers various aspects of controlling TB
using technological innovations. Apart from web based technology, SMS services have been used
effectively for communication with patients and monitoring the programme on day to day basis.

DOUBLE RATION

Double ration is supplied to the TB affected children on DOTS / children from TB affected families /
children on INH (children below six years) to improve the nutritional and health status of children for a period
of one year under ICDS.

29
ROLE OF SPHO AS MOTC IN MONITORING THE RNTCP
IN RESPECTIVE CLUSTER AREA

The following activities must be undertaken by the SPHO as part of the role as MOTC:

 SPHO to conduct monthly/ periodic review meetings at cluster level in consultation with DTCO

(District TB Control Ofcer).

 SPHO should identify nodal person from each PHC (Male or female of MPHS cadre to look after TB

program exclusively) and should get it approved by DMHO

 Should include RNTCP in the supervisory agenda during their routine eld visits for supervision at

least 7 days per month

 Should ensure RNTCP drugs & stock management by the Pharmacist or designated staff at PHCs

 Cover all Designated Microscopy centres (DMCs), Peripheral Health Institutes (PHIs), DOT centres,

DRTB Centres (if present), Drug stores, ART centres (if present), ICTC, and Community care centres
in the jurisdiction assigned to SPHO per month to review RNTCP indicators in eld level

 Ensure that at least 3 patients are interviewed per visit and make sure to include MDRTB, pediatric TB

and TBHIV patients

 Ensure early diagnosis and complete treatment for all TB cases.

 Verify the TB treatment cards and monitor regular updation of the cards during the monthly meeting

 Monitor the program progress against the indicators

 Ensure completion of all formats and reporting in time

 Maintain the Referral Register and feedback registers for all PHIs across TUs.

 Maintain line lists of TB referrals to DMCs from general OP

 Maintain line lists of PMDT (Program Management of Drug Resistant Tuberculosis)

 Monitor progress of PMDT in the respective cluster

 SPHO should attend the monthly/quarterly review meetings called upon by DTO in consultation with

DM&HO

30
 ROLE OF SPHOs IN NON COMMUNICABLE DISEASES

All these Programmes should be monitored with MPHEO/SUO.

NATIONAL PROGRAM FOR PREVENTION AND CONTROL OF CANCER, DIABETES, CVD'S AND
STROKE and NATIONAL PROGRAM FOR HEALTH CARE OF THE ELDERLY
• To ensure all SCs to check BP and BS examination for above 30 years of age
• Ensure CHCs are conducting specialty clinics
• Ensure proper utilization of funds released to SPHO
• Ensure timely reporting from Sub- centre, PHC and CHC
NIIDDCP: (NATIONAL IODINE DEFICIENCY DISORDERS CONTROL PROGRAM)
• Health Education and publicity by conducting awareness camps on usage of iodized salt
• Conduct medical camps for children between 6-12 years and examine for goiter
• To ensure that salt testing is done by ASHAs as and when the kits are supplied to them
NPPCF: (NATIONAL PROGRAM FOR PREVENTION AND CONTROL OF FLUOROSIS)
• To co-ordinate with RWS department and help people drink safe water (Free from Fluoride)
• To see that the water samples are collected and testing is done for the Fluoride content
• To visit schools and check for dental uoride cases
• Awareness camps to be conducted on the ill effects of uoride
• Co-ordinate with district NPPCF Cell
NTCP: (NATIONAL TOBACCO CONTROLPROGRAM)
• SPHO is the authorized ofcer to implement NTCP in CHNC area
• Ensure Tobacco free schools (NO Tobacco products should be sold within 100 meters from school
campus)
• See that all Subcentres PHCs and CHCs are smoke free. TO conduct IEC activities

SPHO – ADMINISTRATIVE AND FINANCIAL POWERS

 Monthly ATP and Tour Diary Approval by SPHOs

 Attendance Certicate

 Sanction of Casual Leaves in consultation with DTCOs

 Approval/ Recommendation of POL bills

 Memo issue powers to both Regular & Contractual staff.

 Approval & Payment of DOT provider honorarium

31
 ROLE OF SPHOs IN NATIONAL LEPROSY ERADICATION PROGRAM

ROLE OF SPHO:

 The SPHO Shall be assisted by DPMO in implementation of NLEP Program

 The APMO at PHC Level (where ever available shall support MO in implementation of NLEP, If APMO
is not available nominate one MPHS for NLEP work)

PROGRAMMATIC:

 SPHO to ensure validation of cases by District Nucleus Team by coordinating with ADM&HO (A&L)
within 2 months of diagnosis of a leprosy case

 Monitor and supervise follow up of case to ensure treatment completion as per the guidelines

 Ensure that Upgraded simplied information system is maintained in every PHC

• ULF 01: Patient treatment card

• ULF 2A PHC Treatment Record for New cases

• ULF 2B PHC Treatment Record for 'Other' cases

• ULF 03: MDT Stock register

• ULF 04 DPMR Assessment card

• ULF 05 Disability Register

• ULF 06 PHC Monthly reporting format

 Visit leprosy colony in the jurisdiction and ensure that line list of persons affected by leprosy is
maintained along with required DPMR servies- MCR foot wear, Self care kits, aids and appliances,
dressing material, AAY cards and disability certicates and disability pension in co-ordination with
ADM&HO (A&L)

 Facilitate linking of RCS eligible cases to RCS centre

 Verify MDT stock management such that the buffer stock is maintained as per the guidelines

 Review of NLEP with the MOs and PHC staff, identify gaps and undertake corrective action

 Review on the implementation of anti-leprosy fortnight and Intensive case detection drive

 Identify high and low endemic areas in his/her jurisdiction and take initiatives for conrmation

 Supervision of APMOs who are present at the PHCs and in their absence identify suitable staff from
the PHC who is responsible for implementation of NLEP

32
  Administrative:

 Monitor and supervise ATP and tour diary of DPMO

 Verify payment of incentives for ASHA for case detection and treatment completion with co-ordination
from ADM&HO (A&L)

 Verify payment of incentives to patients who have undergone RCS as per the guidelines. Co-ordinate
with ADM&HO (A&L) for payment of incentives

NLEP PERFORMANCE INDICATORS:

 Annual new case detection rate (ANCDR) per 1 ,00,000 population

 Prevalence rate per 10,000 population

 Child detection rate per 1,00,000 population

 Treatment completion rate

 Proportion of Grade 2 disablity among new cases

 Proportion of child cases among new cases

 Proportion of MB cases among new cases

 Proportion of female cases among new cases

 Proportion of SC cases among new cases

 Proportion of ST cases among new cases

 Proportion of cases diagnosed correctly (Validation)

 No. of cases on MDT

 Developed new or additional disability

33
 ROLE OF SPHOs IN NATIONAL PROGRAM FOR CONTROL OF BLINDNESS

Role of SPHO
PROGRAMMATIC:
 Monitor the Program with PMOO

 Monitoring and supervision of NGOs performing cataract surgeries in the CHNC area

 Facilitate conrmation of cataract cases in the area and report to DBCS

 Facilitate distribution of spectacles to school children with refractive errors

 Plan IEC activities coordinating with DPM of DBCS

 Ensure to maintain Blind register at village level and CHNC level by PMOOs with the help of ASHAs
and Health Assistants (M&F)
 To ensure distribution of Vit A by PHC staff

 To facilitate creating awareness in the community on Vitamin A rich food, personal hygiene and eye
care in co-ordination with Health educator and PMOO
 To verify training of school teachers, ASHA s and volunteers in the prevention and control of blindness

 Maintain list of eye hospitals/nursing homes and eye surgeons in the jurisdiction of CHNC

ADMINISTRATIVE:
 Verication and certication of cataract surgeries performed by NGOs in the jurisdiction of CHNC.

 Approve the tour diary of PMOO

 Verication of PMOOs monthly report and onward submission to the DPM after his/her signature

 To co-ordinate with RKSK school children examination with eye screening.

 To facilitate referral of Eye diseases other than refractive errors and cataract identied, to District
hospital/Medical College hospital for further management
 Ensure payment of incentives to ASHA promptly

NPCB PERFORMANCE INDICATORS:

• No. of cataract cases referred to Govt institutions for surgery
• No. of other eye diseases referred to District Hospital/Medical College Hospital
• No. of school children examined
• No. of free spectacles distributed
• No. of eye camps conducted

34
 ROLE OF SPHOs IN HMIS & MCTS
HMIS
Health Management Information System is dened as a system that provides up to date, relevant,
adequate, timely, reliable and reasonably complete information to health managers at various level and
sharing of technical and scientic information by health personnel in order to make well informed
management decisions about programme performance and operations. This information is useful in
planning and control functions of the managers and help them in decision making.
A Model Field register is being prepared and it has to be maintained at all sub centres.
The Following Reports are generated at PHC level and they should be entered in to the portal at PHC
only.
 MPHEO is responsible for entering data at PHC.
• Aggregate report of sub centre activities. Staff position number of posts lled and vacancies category
wise, transport or vehicles, equipments and supply position.
• Malaria report- Monthly report of blood slides
• Tuberculosis report. Revised national tuberculosis control programme. Monthly report of logistics and
microscopy
• School health report
• Epidemic and notied diseases and IDSP
• AFP-Surveillance
• Family planning achievements
• Immunization report
• Input proforma for sterilization, Detailed report on sterilization cases ( age, sex, caste, education and
number of children)
• Input proforma for IUD (age, caste, education and number of children)
• Department wise achievement of family planning
• National planning on control of blindness monitoring
• Monthly report of PHC and CHC
• Medical termination of pregnancy
• Monthly expenditure statement
HMIS REPORT CONSISTS OF THE FOLLOWING MODULES1
PART A: REPRODUCTIVE & CHILD HEALTH
• M1: Antenatal Care Services
• M2: Deliveries
• M3: Pregnancy Outcomes and detail of Newborn
• M4: Post-Natal care
• M5: Family Planning
• M6: Child Immunization
• M7: Number of Vitamin A Doses

35
PART B : HEALTH FACILITIES SERVICES
• M9: Patient Services
• M10: Laboratory Testing
PART C: LINE LISTING OF DEATHS
• S. No. 34- Mortality Details
• PART B : HEALTH FACILITIES SERVICES
• M9: Patient Services
• M10: Laboratory Testing
• PART C: LINE LISTING OF DEATHS
• S. No. 34- Mortality Details

MCTS
• Mother & Child Tracking System(MCTS) is a centralized web based application for improving delivery
of health care services to pregnant women and children up to ve years of age through name based
tracking of each beneciary and monitoring service delivery. It has been declared as a Mission Mode
Project under the National e-Governance Plan (NeGP) in July 2011.
Expectation from Health managers/Health Service Providers at different levels and for different process
are as follows
• Data collection, Data entry and data updating in the system – there should be as minimum as possible
time gap between the actual service delivery and updating of data in the MCTS. It should be less than
a week
• Work Plan – work plan should be regularly generated and timely distributed to eld level health
service providers so that its proper utilization can be there
• Maintenance of quality of data - IT managers at various level as well as health administrators should
regularly review the data in MCTS and help in improving its quality
• Regular review meeting – there should be regular review meeting on MCTS implementation at all
levels (state level or district level or block level)
USES OF MCTS
• Medical ofcers at all the levels should use the MCTS data for reviewing the progress of their
catchment area
• Use of MCTS data as the only source of information for review of RCH services
• Senior level health managers/Administrators ( State level) should use the MCTS data to take the
policy decision for the different schemes and health related programmes, identify the bottlenecks
• Middle level health managers/ Administrators should use the MCTS data for micro level planning like
distribution of vaccines/drugs, logistics, Human resource etc.

36
OBJECTIVES
To ensure that
• All pregnant women should receive their:
– Full Ante Natal Care (ANCs) services at due time
– Full Post Natal Care (PNCs) services at due time
• Encourage institutional delivery particularly of high risk mothers
• All children should receive their full immunisation at due time
This will help improve IMR, MMR, TFR and morbidity in women and children

ROLE OF SPHO
• SPHOs shall observe in the eld regarding MCTS in relation to the Field service registers of ANM and
AWW
• Shall conduct Periodic review meetings monthly with MOs basing on the information from the Portal
• Should not entertain any Manual collection of data and stick to only Portal data
• CHO of CHNC is responsible for all Portal entries at CHNC level and Co ordinate with MPHEOS of
PHCs for timely entering of data
37
 Role of SPHOs in 104 SERVICES

• Shall prepare roster for Medical Ofcers in the CHNC for attending clinics and ensure the attendance
of MO at every clinic
• Ensure every MHU conducts 100 % clinics as per the Fixed Schedule
• Ensure the attendance of MO in at every Fixed Day Clinic
• Ensure availability of Medicines in MHUs by coordinating with CDS and PHCs

Role of SPHOs in 108 SERVICES

• Each CHNC has one /two ambulances

• Every SPHO shall inspect every ambulance at least once in a month
• Increase the utilisation of 108 services by pregnant women by sensitising ASHAs and ANMs
• Ensure Intra Facility Transfer through 108 ambulances

38
 BRIEF ON AP CIVIL SERVICES (CONDUCT) RULES
AP CIVIL SERVICES (CCA) RULES

Sensitisation on existing rules governing services of employees:

A. Fundamental Rules: 1.Explain the denitions of
a. Duty
b. Pay
c. Allowances
2. Explain the process of
a. Pay xation, Increments
b. Deputation
c. Lien
B. AP State and Subordinate Service Rules: envisage about the
i. Method of appointment
ii. Recruitment method
iii. Promotion process
iv. Rule of reservation
v. Recruitment
vi. b. Promotions
vii. Transfer of employee
C. AP CS (CCA) Rules
Under Rule 3 :
Every Government employee shall be devoted to his duty and shall maintain absolute integrity, discipline,
impartiality and a sense of propriety.
No Government employee shall behave in a manner which is unbecoming of such employee or
derogatory to the prestige of Government.
No Government employee shall act in a manner which will place his ofcial position under any kind of
embarrassment
No Government employee shall In the performance if his Ofcial duties act in a discourteous and
discriminate manner with any working women or indulge in sexual harassment either directly or by
implication.
Rule 4 :
No Government employee shall participate in any strike or similar activities of incitement thereto.
Rule 5 :
No Government employee shall participate in any demonstration which is against the interests of the
sovereignty and integrity of India or Public order.

39
Rule 6 :
No Government employee shall accept any gift, or any service the performance of which will place such
employee under any kind of ofcial obligation or embarrassment
Every Government employee shall intimate to the competent Authority within fteen days form the date
of receipt of any foreign currency or foreign goods of value of more than Rs. 10,000/-
Rule 7 :
No Government employee shall participate in the raising of, any subscriptions or their pecuniary
assistance in pursuance of any object whatsoever.
Rule 8 :
No Government employee shall save in the public limited company, himself or through any member of
his family or any person acting on his behalf.
Rule 9 :
12. No Government employee shall, except after previous intimation to Government, acquire or dispose
of, or permit any member of his family to acquire or dispose of, any immovable property
Rule 10 :
No Government employee shall engaged directly or indirectly in any trade or business save in the course
of his ofcial duties.
Rule 11 :
No Government employee shall in his private capacity, except with the previous sanction of
Government, take part in the promotion, registration or management of any bank or other company
registered under the relevant law for the time being in force.
Rule 12 :
No Government employee shall, except with the previous sanction of Government negotiate for or
undertake any employment or work other than that connected with the ofcial duties.
Rule 13 :
No Government employee shall, without the previous permission of Government, publish any book
Rule 15 :
No Government employee shall, except with the previous sanction of Government, own wholly or in part,
or conduct, or participate in the editing or the management of, any newspaper or non-government
publication.
Rule 16 :
No Government employee shall, criticise any policy or action of Government or any other State
Government or the Central Government, nor shall he participate in any such criticism.
Rule 18 :
No Government employee shall without previous sanction of government give evidence in connection
with any inquiry conducted by any committee, commission or other authority.
Rule 19 :
No Government employee shall be a member of or be otherwise associated with, any political party

40
Rule 21 :
Every member of a state service shall inform his immediate ofcial superior if a member of a state or
subordinate service, who is his near relative is to work under him.
Rule 22 :
When ever a member of the family of a Government employee who is solely dependent on him wishes to
accept employment under any person, or with any rm or company, having ofcial connection with such
Government employee or Government, the Government employee shall obtain the prior sanction of
Government for such employment.
Rule 23 :
No Government employee shall deal, in his ofcial capacity with any matter which directly or indirectly
concerns him or any of his relatives or dependents.
Rule 25 :
No Government employee shall bring or attempt to bring any extraneous inuence to bear up on any
authorities for the furtherance of his interest
Rule 24 :
No Government employee who has a wife living shall contract another marriage without rst obtaining
the permission of the Government, not with standing that such subsequent marriage, is permissible under
the personal law for the time being applicable to him.
Rule 26 :
No Government servant shall give or take or abet in giving or taking of dowry.
Rule 27 :
Not with standing any thing contained in the provisions of any Law relating to intoxicating drinks or drugs
for the time being in force in any, area, no Government employee shall.
AP Civil Services ( CCA ) Rules:
According to AP Civil Services (CCA) Rules, No Punishment shall be given to any employee without
giving reasonable opportunity and following due procedures and formats.
MINOR PENALTIES:
1. Censure
2. Withholding of promotion
3. Withholding of increments without cumulative effect
4. Reduction to a lower stage in the time scale of pay for a period not exceeding 3 years.
MAJOR PENALTIES:
1. Withholding of increments of Pay with cumulative effect.
2. Reduction to lower time scale
3. Compulsory retirement
4. Removal from Service
5. Dismissal from Service

41
PROCESS FOR DISCIPLINARY PROCEDURES IS AS SHOWN BELOW:

1. Conducting preliminary Enquiry/ Report from Ofcers / FIR

2. Framing article of charges in the prescribed format.

3. Serving Article of Charges to employee with dated acknowledgement.

4. Report of Reply with in stipulated time.

5. Conduct the detailed enquiry/drop the further disciplinary procedures.

6. Appointment of Inquiry ofcer.

7. Conducting Enquiry by IO and Solutions report to disciplinary authorities.

8. Drop the Chargers on Report (or) decided to impose penalty.

9. In-case of penalty, Communicating Enquiry report to employees

10. Decision to impose type of Penalty and communicating the decision to employee.

11. Imposing penalty

42
 BRIEF ON RIGHT TO INFORMATION ACT

BASIC TENETS UNDER RTI ACT ARE:

• Disclosure a rule and Secrecy an exception
• Transparency means public interest
• Public Interest overrides
• It is a part of Global Process.
• Governance will improve
INFORMATION :
Information includes records, documents, memos, e-mails, opinions, advises, press releases,
circulars, orders, log-books, contracts, reports, papers, samples, models, data held in electronic form. Also
includes information relating to any private body which can be accessed by a public authority.
RIGHT TO INFORMATION MEANS:
1. Inspection of work, documents, records
2. Taking notes, extracts, or certied copies of documents or records
3. Taking certied samples of material
4. Obtaining information in the form of diskettes, oppies, tapes, video cassettes or in any other
electronic mode or through printouts where such information is stored in a computer or in any other device
OBLIGATIONS OF PUBLIC AUTHORITIES UNDER RTI ACT ARE AS SHOWN BELOW:
1. Every public authority shall maintain all its records duly catalogued and indexed
2. Shall also publish the information of the organization regarding
a. Structure
b. Functions and duties
c. Procedure followed
d. Decision making process
e. Directory of ofcers and employees
f. Names and designations of public information ofcers.
3. Every ofce shall appoint minimum of one PIO and one APIO and Appellate authority and publish their
particulars on the board in the ofce premises
PROCEDURE FOR OBTAINING INFORMATION FROM THE SOURCE OFFICES UNDER RTI ACT:
• Every person seeking the information shall request in writing or through electronic means paying the
requisite fees
• Upon the receipt of application PIO shall provide information or reject with in 30 days from receipt of
application
• In case information requested is not pertains to PIO, application has to be transferred to concerned
PIO with in 7 days from receipt of application

43
 • In case of rejection of request, PIO shall communicate to the applicant with the reasons of such
rejection, period within which appeal can be led particulars of appellant authority.
• Public Information Ofcer intends to disclose any information which relates to a third party and treated
as condential by that third party, he shall be invited to know whether the information should be
disclosed.
• Except, in case of trade or commercial secrets protected by law, disclosure may be allowed if the public
interest in disclosure outweighs in importance any possible harm or injury to the interest of such third
party.
APPEALS:
• Appeal can be lled before appellate authority for non- receipt of information or rejection of application
within 30 days from the receipt of rejection or expiry of period for providing information.
• Second appeal against the decision of rst appeal shall be within the 90 days from the date on which
decision made or actually received. Second appellate authority is state information commission
FEES:
• In respect of public authorities at the Village Level – No fee
• In respect of public authorities at Mandal Level – Rs. 5/- per application
• Introspect of public authorities other than those covered above – Rs. 10/- per application
PRICED MATERIAL :
• The sale price of publications printed matter, text, maps, plans, oppies, CDs, samples, models or
material in any other form.
OTHER THAN PRICED MATERIAL :
• Material in printed or text form (in A4 or A3 size paper) Rs.2/- per each page per copy;
• Material in printed or text form in larger than A4 or A3 size paper - actual cost thereof;
• Maps and plans – actual cost thereof;
• Information in Electronic format viz., Floppy, CD or DVD:
(a) Rupees fty for Floppy of 1.44 MB;
(b) Rupees one hundred for CD of 700 MB; and
(c) Rupees two hundred for CD (DVD).
MAINTENANCE OF REPORTS AND REGISTERS:
• Every PIO shall maintain register – 1 for recording status of reports received from persons seeking
information it should also contain number of request received, disposed, rejected and pending along
with the amount collected.
• Every PIO shall maintain register – 2 for recording status of appeals lled before him with regards to
the date of receipts and their disposals etc.
• Every PIO shall submit the quarterly reports to the district ofcer in the prescribed format to the District
Ofce. District Ofce shall consolidated all such reports and submit to HoD. HoD shall consolidate
and submit to secretariat department .

44
PENALTIES PROVIDED UNDER THE ACT :

• Require the public authority to compensate the complainant for any loss or other detriment suffered.

• Impose a penalty of Rs.250/- each day not exceeding Rs.25,000/- till application is received or
information furnished.

• Also recommend for disciplinary actions against Central Public Information Ofcer or State Public
Information Ofcer under Service Rules applicable to them.

• The burden proving that he acted reasonably or diligently is on the Central Public Information Ofcer
or State Public Information Ofcer.

• The Penal provisions are the real teeth of the Act, which if properly implemented will bring the rule of
law into governance.

EXEMPTION CLAUSE IN DETAIL:

• National security

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45
Indian Public Health Standards (IPHS)
for Primary Health Centres (PHCs)

46
 INDIAN PUBLIC HEALTH STANDARDS (IPHS)
FOR PRIMARY HEALTH CENTRES (PHCs)
In order to provide optimal level of quality health care, a set of standards are being recommended for PHC.
The standards prescribed in this document are for a PHC covering 20,000 to 30,000 populations with 6 beds,
as all block level PHCs are ultimately going to be upgraded as CHCs with 30 beds for providing specialized
services.
ASSURED SERVICES AT THE PHCs
From Service delivery angle, PHCs may be of two types, depending upon the delivery case load – Type
A and Type B.
 Type A PHC: PHC with delivery load of less than 20 deliveries in a month
 Type B PHC: PHC with delivery load of 20 or more deliveries in a month
ALL THE FOLLOWING SERVICES HAVE BEEN CLASSIFIED AS
 Essential (Minimum Assured Services) or
 Desirable (which all States/UTs should aspire to achieve at this level of facility)
Essential
 OPD services: A total of 6 hours of OPD services out of which 4 hours in the morning and 2 hours in
the afternoon for six days in a week. Time schedule will vary from state to state. Minimum OPD
attendance is expected to be 40 patients per doctor per day. In addition to six hours of duty at the
PHC, it is desirable that MO PHC shall spend at least two hours per day twice in a week for eld
duties and monitoring.
 24 hours emergency services: appropriate management of injuries and accident, First Aid,
stitching of wounds, incision and drainage of abscess, stabilization of the condition of the patient
before referral, Dog bite/snake bite/scorpion bite cases, and other emergency conditions. These
services will be provided primarily by the nursing staff. However, in case of need, Medical Ofcer
may be available to attend to emergencies on call basis.
 Referral services.
 In-patient services (6 beds).
MATERNAL AND CHILD HEALTH CARE INCLUDING FAMILY PLANNING
Essential
a) Antenatal care
i. Early registration of all pregnancies ideally in the rst 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. Record tobacco use by all antenatal
mothers.
Minimum 4 antenatal checkups and provision of complete package of services. Suggested schedule for
antenatal visits:
 1st visit: Within 12 weeks—preferably as soon as pregnancy is suspected—for registration of
pregnancy and rst antenatal check-up
 2nd visit: Between 14 and 26 weeks
 3rd visit: Between 28 and 34 weeks
 4th visit: Between 36 weeks and term
47
 i. Associated services like providing iron and folic acid tablets, injection Tetanus Toxoid etc (as per the
“guidelines for Ante-Natal Care and Skilled Attendance at birth by ANMs and LHVs) Ensure, at-least
1 ANC preferably the 3rd visit, must be seen by a doctor.
ii. Minimum laboratory investigations like Haemoglobin, Urine albumin and sugar, RPR test for syphilis
and Blood Grouping and Rh typing.
iii. Nutrition and health counseling. Brief advice on tobacco cessation if the antenatal mother is a
smoker or tobacco user and also inform about dangers of second hand smoke.
iv. Identication and management of high risk and alarming signs during pregnancy and labour.
v. Timely referral of such identied cases to FRUs/ other hospitals which are beyond the capacity of
Medical Ofcer PHC to manage.
vi. Tracking of missed and left out ANC.
vii. Chemoprophylaxis for Malaria in high malaria endemic areas for pregnant women as per NVBDCP
guidelines.
b) INTRA-NATAL CARE: (24-hour delivery services both normal and assisted)
i. Promotion of institutional deliveries.
ii. Management of normal deliveries.
iii. Assisted vaginal deliveries including forceps/vacuum delivery whenever required.
iv. Manual removal of placenta.
v. Appropriate and prompt referral for cases needing specialist care.
vi. Management of pregnancy Induced hypertension including referral.
vii. Pre-referral management (Obstetric rst-aid) in Obstetric emergencies that need expert assistance
(Training of staff for emergency management to be ensured).
viii. Minimum 48 hours of stay after delivery.
ix. Managing labour using Partograph.
c) Procient in identication and basic rst aid treatment for PPH, Eclampsia, Sepsis and prompt
referral As per 'Antenatal Care and Skilled Birth Attendance at Birth' Guidelines
d) POSTNATAL CARE
i. Ensure post- natal care for 0 & 3rd day at the health facility both for the mother and new-born and
sending direction to the ANM of the concerned area for ensuring 7th & 42nd day post-natal home
visits. 3 additional visits for a low birth weight baby (less than 2500 gm) on 14th day, 21st day and on
28th day.
ii. Initiation of early breast-feeding within one hour of birth.
iii. Counseling on nutrition, hygiene, contraception, essential new born care (As per Guidelines of GOI
on Essential new-born care) and immunization.
iv. Others: Provision of facilities under Janani Suraksha Yojana (JSY).
v. Tracking of missed and left out PNC.
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e) NEW BORN CARE
i. Facilities for Essential New Born Care (ENBC) and Resuscitation (Newborn Care Corner in Labour
Room/OT, Details given in Annexure 3A).
ii. Early initiation of breast feeding within one hour of birth.
iii. Management of neonatal hypothermia (provision of warmth/Kangaroo Mother Care (KMC).
i. infection protection, cord care and identication of sick newborn and prompt referral.
f) CARE OF THE CHILD
i. Routine and Emergency care of sick children including Integrated Management of Neonatal and
Childhood Illnesses (IMNCI) strategy and inpatient care. Prompt referral of sick children requiring
specialist care.
ii. Counseling on exclusive breast-feeding for 6 months and appropriate and adequate complementary
feeding from 6 months of age while continuing breastfeeding. (As per National Guidelines on Infant
and Young Child Feeding, 2006, by Ministry of WCD, Government of India).
iii. Assess the growth and development of the infants and under 5 children and make timely referral.
iv. Full Immunization of all infants and children against vaccine preventable diseases as per guidelines of
GOI.
v. Vitamin A prophylaxis to the children as per national guidelines.
vi. Prevention and control of routine childhood diseases, infections like diarrhoea, pneumonia etc. and
anemia etc.
vii. Management of severe acute malnutrition cases and referral of serious cases after initiation of
treatment as per facility based guidelines.
JANANI SURAKSHA YOJANA
Janani Suraksha Yojana (JSY) is a safe motherhood intervention under the National Rural Health
Mission (NRHM) being implemented with the objective of reducing maternal and neo-natal mortality by
promoting institutional delivery among the poor pregnant women. This scheme integrates cash assistance
with delivery and post-delivery care.
While the scheme would create demand for institutional delivery, it would be necessary to have
adequate number of 24X7 delivery services centre, doctors, mid-wives, drugs etc. at appropriate places.
Mainly, this will entail
 Linking each habitation (village or a ward in an urban area) to a functional health centre- public or
accredited private institution where 24X7 delivery service would be available.
 Associate an ASHA or a health link worker to each of these functional health centre.

 It should be ensured that ASHA keeps track of all expectant mothers and newborn. All expectant
mother and newborn should avail ANC and immunization services, if not in health centres, at least on
the monthly health and nutrition day, to be organized in the Anganwadi or sub-centre.

49
  Each pregnant woman is registered and a micro birth plan is prepared.
 Each pregnant woman is tracked for ANC.
 For each of the expectant mother, a place of delivery is pre-determined at the time of registration and
the expectant mother is informed.
 A referral centre is identied and expectant mother is informed.
 ASHA and ANM to ensure that adequate fund is available for disbursement to expectant mother.
 ASHA takes adequate steps to organize transport for taking the women to the pre-determined health
institution for delivery.
 ASHA assures availability of cash for disbursement at the health centre and she escorts pregnant
women to the pre-determined health centre.
 ASHA package in the form of cash assistance for referral transport, cash incentive and transactional
cost to be provided as per guidelines.
JANANI SHISHU SURAKSHA KARYAKRAM (JSSK)
JSSK launched on 1st of June of 2011 is an initiative to assure free services to all pregnant women and sick
neonates accessing public health institutions. The scheme envisages free and cashless services to
pregnant women including normal deliveries and caesarian section operations and also treatment of sick
newborn (up to 30 days after birth) in all Government health institutions across State/UT. This initiative
supplements the cash assistance given to pregnant women under the JSY and is aimed at mitigating the
burden of out of pocket expenditure incurred by pregnant women and sick newborns.
ENTITLEMENTS FOR PREGNANT WOMEN
1. Free and Zero expense delivery and Caesarian Section
2. Free Drugs and Consumables
3. Free Diagnostics (Blood, Urine tests and Ultrasonography etc. as required.)
4. Free diet during stay in the health institutions (up to 3 days fro normal deliveries and upto 7 days for
caesarian deliveries)
5. Free provision of the Blood
6. Free transport from home to health institutions, between facilities in case of referrals and drop back
from institutions to home
7. Exemption from all kinds of user charges
ENTITLEMENTS FOR SICK NEWBORN TILL 30 DAYS AFTER BIRTH
1. Free and zero expense treatment
2. Free Drugs and Consumables
3. Free Diagnostics
4. Free provision of the Blood
5. Free transport from home to health institutions, between facilities in case of referrals and drop back
from institutions to home.
6. Exemption from all kinds of user charges

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g) FAMILY WELFARE
i. Education, Motivation and Counseling to adopt appropriate Family planning methods.
ii. Provision of contraceptives such as condoms, oral pills, emergency contraceptives, IUCD insertions.
iii. Referral and Follow up services to the eligible couples adopting permanent methods
(Tubectomy/Vasectomy).
iv. Counseling and appropriate referral for couples having infertility.
v. Permanent methods like Tubal ligation and vasectomy/NSV, where trained personnel and facility
exist.
MEDICAL TERMINATION OF PREGNANCIES
Essential
 Counseling and appropriate referral for safe abortion services (MTP) for those in need.
Desirable
 MTP using Manual Vacuum Aspiration (MVA) technique will be provided in PHCs, where trained
personnel and facility exist.
 Medical Method of Abortion with linkage for timely referral to the facility approved for 2nd trimester of
MTP.
MANAGEMENT OF REPRODUCTIVE TRACT INFECTIONS/SEXUALLY TRANSMITTED
INFECTIONS
Essential
 Health education for prevention of RTI/STIs
 Treatment of RTI/STIs
NUTRITION SERVICES (COORDINATED WITH ICDS)
Essential
 Diagnosis of and nutrition advice to malnourished children, pregnant women and others
 Diagnosis and management of anaemia and vitamin A deciency
 Coordination with ICDS
SCHOOL HEALTH
Teachers screen students on a continuous basis and ANMs/HWMs (a team of 2 workers) visit the schools
(one school every week) for screening, treatment of minor ailments and referral. Doctor from CHC/PHC will
also visit one school per week based on the screening reports submitted by the teams.
Overall services to be provided under school health shall include
Essential
 Health service provision
SCREENING, HEALTH CARE AND REFERRAL:
 Screening of general health, assessment of Anemia/Nutritional status, visual acuity, hearing
problems, dental check up, common skin conditions, Heart defects, physical disabilities, learning

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  Basic medicines to take care of common ailments, prevalent among young school going children.
 Referral Cards for priority services at District/ Sub-District hospitals.
IMMUNIZATION
 As per national schedule
 Fixed day activity
 Coupled with education about the issue
MICRO NUTRIENT (VITAMIN A & IFA) MANAGEMENT:
 Weekly supervised distribution of Iron-Foliate tablets coupled with education about the issue
 Administration of Vitamin-A in needy cases
DE-WORMING
 Biannually supervised schedule
 Prior IEC
 Siblings of students also to be covered
CAPACITY BUILDING
MONITORING & EVALUATION
 Mid Day Meal: In coordination with department of school education, Ministry of Human Resource
Development
DESIRABLE
 Health Promoting Schools
 Counseling services
 Regular practice of Yoga, Physical education, health education
 Peer leaders as health educators
 Adolescent health education-existing in few places
 Linkages with the out of school children
 Health clubs, Health cabinets
 First Aid room/corners or clinics
ADOLESCENT HEALTH CARE
To be provided preferably through adolescent friendly clinic for 2 hours once a week on a xed day.
Services should be comprehensive i.e. a judicious mix of promotive, preventive, curative and referral
services
Core package (Essential)
 Adolescent and Reproductive Health: Information, counseling and services related to sexual
concerns, pregnancy, contraception, abortion, menstrual problems etc
 Services for tetanus immunization of adolescents
 Nutritional Counseling, Prevention and management of nutritional anemia
 STI/RTI management
 Referral Services for VCTC and PPTCT services and services for Safe termination of pregnancy, if
not available at PHC
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OPTIONAL/ADDITIONAL SERVICES (DESIRABLE): AS PER LOCAL NEED
Outreach services in schools (essential) and community Camps (desirable)
 Periodic Health checkups and health education activities, awareness generation and Co-curricular
activities Promotion of Safe Drinking Water and Basic Sanitation
Essential
 Disinfection of water sources and Coordination with Public Health Engineering department for safe
water supply.
 Promotion of sanitation including use of toilets and appropriate garbage disposal.
Desirable
 Testing of water quality using H2S - Strip Test (Bacteriological). Prevention and control of locally
endemic diseases like malaria, Kala Azar, Japanese Encephalitis etc.
 Essential - Collection and reporting of vital events.
 Essential - Health Education and Behaviour Change Communication (BCC).
 Essential - Other National Health Programmes
REVISED NATIONAL TUBERCULOSIS CONTROL PROGRAMME (RNTCP)
Essential
All PHCs to function as DOTS Centres to deliver treatment as per RNTCP treatment guidelines through
DOTS providers and treatment of common complications of TB and side effects of drugs, record and report
on RNTCP activities as per guidelines. Facility for Collection and transport of sputum samples should be
available as per the RNTCP guidelines.
NATIONAL LEPROSY ERADICATION PROGRAMME
Essential
 Health education to community regarding Leprosy.
 Diagnosis and management of Leprosy and its complications including reactions.
 Training of leprosy patients having ulcers for self-care.
 Counselling for leprosy patients for regularity completion of treatment and prevention of disability.
INTEGRATED DISEASE SURVEILLANCE PROJECT (IDSP)
Essential
 Weekly reporting of epidemic prone diseases a. in S, P & L forms and SOS reporting of any cluster
of cases.
 PHC will collect and analyze data from Sub-Centre and will report information to district surveillance
unit.
 Appropriate preparedness and rst level action in out-break situations.
 Laboratory services for diagnosis of Malaria, Tuberculosis, and tests for detection of faecal
contamination of water (Rapid test kit) and chlorination level.

53
NATIONAL PROGRAMME FOR CONTROL OF BLINDNESS (NPCB)
Essential
 The early detection of visual impairment and their referral.
 Detection of cataract cases and referral for cataract surgery.
 Provision of Basic treatment of common eye diseases.
 Awareness generation through appropriate IEC strategies for prevention and early detection of
impaired vision and other eye conditions.
 Greater participation/role of community in primary prevention of eye problems.
NATIONAL VECTOR BORNE DISEASE CONTROL PROGRAMME (NVBDCP)
Essential in endemic areas

Diagnosis and Management of Vector borne Diseases is to be undertaken as per NVBDCP guidelines
for PHC/CHC:
 Diagnosis of Malaria cases, microscopic conrmation and treatment.
 Cases of suspected JE and Dengue to be provided symptomatic treatment, hospitalization and
case management as per the protocols.
 Complete treatment to Kala-azar cases in Kala-azar endemic areas as per national Policy.
 Complete treatment of microlaria positive cases with DEC and participation in and arrangement
for Mass Drug Administration (MDA) along with management of side reactions, if any. Morbidity
management of Lymphoedema cases.
NATIONAL AIDS CONTROL PROGRAMME
Essential
 IEC activities to enhance awareness and preventive measures about STIs and HIV/AIDS,
Prevention of Parents to Child Transmission (PPTCT) services.
 Organizing School Health Education Programme.
 Condom Promotion & distribution of condoms to the high risk groups.
 Help and guide patients with HIV/AIDS receiving ART with focus on adherence.
Desirable
 Integrated Counseling and Testing Centre, STI services.
 Screening of persons practicing high-risk behaviour with one rapid test to be conducted at the PHC
level and development of referral linkages with the nearest ICTC at the District Hospital level for
conrmation of HIV status of those found positive at one test stage in the high prevalence states.
 Risk screening of antenatal mothers with one rapid test for HIV and to establish referral linkages
with CHC or District Hospital for PPTCT services in the six high HIV prevalence states (Tamil Nadu,
Andhra Pradesh, Maharashtra, Karnataka, Manipur and Nagaland) of India.
 Linkage with Microscopy Centre for HIV-TB coordination.
 Pre and post-test counseling of AIDS patients by PHC staff in high prevalence states.

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NATIONAL PROGRAMME FOR PREVENTION AND CONTROL OF DEAFNESS (NPPCD)
Essential
 Early detection of cases of hearing impairment and deafness and referral.
 Basic Diagnosis and treatment services for common ear diseases like wax in ear, otomycosis,
otitisexterna, Ear discharge etc.
 IEC services for prevention, early detection of hearing impairment/deafness and greater
participation/role of community in primary prevention of ear problems.
NATIONAL MENTAL HEALTH PROGRAMME (NMHP)
Essential
 Early identication (diagnosis) and treatment of mental illness in the community.
 Basic Services: Diagnosis and treatment of common mental disorders such as psychosis,
depression, anxiety disorders and epilepsy and referral.
 IEC activities for prevention, stigma removal, early detection of mental disorders and greater
participation/role of Community for primary prevention of mental disorders.
NATIONAL PROGRAMME FOR PREVENTION AND CONTROL OF CANCER, DIABETES, CVD
AND STROKE (NPCDCS)
Essential
 IEC services for prevention of cancer and early symptoms.
 Early detection of cancer with warning signals like change in Bladder/Bowel habits, bleeding per
rectum, blood in urine, lymph node enlargement, Lump or thickening in Breast, itching and/or
redness or soreness of the nipples of Breast, non healing chronic sore or ulcer in oral cavity,
difculty in swallowing, obvious change in a wart/mole, nagging cough or hoarseness of voice etc.
 Referral of suspected cancer cases with early warning signals for conrmation of the diagnosis.
Desirable
 PAP smear
 Other NCD Diseases
Essential
 Health Promotion Services to modify individual, group and community behaviour
 Promotion of Healthy Dietary Habits
 Increase physical activity
 Avoidance of tobacco and alcohol
 Stress Management
 Early detection, management and referral of Diabetes Mellitus, Hypertension and other
Cardiovascular diseases and Stroke through simple measures like history, measuring blood
pressure, checking for blood, urine, sugar and ECG

55
Desirable
 Survey of population to identify vulnerable, high risk and those suffering from disease
NATIONAL IODINE DEFICIENCY DISORDERS CONTROL PROGRAMME (NIDDCP)
Essential
 IEC activities to promote the consumption of iodized salt by the people
 Monitoring of Iodized salt through salt testing kits
NATIONAL PROGRAMME FOR PREVENTION AND CONTROL OF FLUOROSIS (NPPCF) (IN
AFFECTED (ENDEMIC DISTRICTS)
Essential
 Referral Services
 IEC activities to prevent Fluorosis
Desirable
 Clinical examination and preliminary diagnostic parameters assessment for cases of Fluorosis if
facilities are available
 Monitoring of village/community level activity
NATIONAL TOBACCO CONTROL PROGRAMME (NTCP)
Essential
 Health education and IEC activities regarding harmful effects of tobacco use and second hand
smoke
 Promoting quitting of tobacco in the community
 Providing brief advice on tobacco cessation to all smokers/tobacco users
 Making PHC tobacco free
Desirable
 Watch for implementation of ban on smoking in public places, sale of tobacco products to minors,
sale of tobacco products within 100 yards of educational institutions
NATIONAL PROGRAMME FOR HEALTH CARE OF ELDERLY
Essential
 IEC activities on healthy aging
Desirable
 Weekly geriatric clinic at PHC' for providing complete health assessment of elderly persons,
Medicines, Management of chronic diseases and referral services
ORAL HEALTH PROGRAMME
Essential
 Oral health promotion and check ups & appropriate referral on identication

56
PHYSICAL MEDICINE AND REHABILITATION (PMR) SERVICES
Desirable
 Primary prevention of Disabilities
 Screening, early identication and detection
 Counseling
 Issue of Disability Certicate for obvious Disabilities by PHC doctor
REFERRAL SERVICES

Appropriate and prompt referral of cases needing specialist care including:
 Stabilization of patient
 Appropriate support to patient during transport
 Providing transport facilities either by PHC vehicle or other available referral transport
TRAINING
Essential
 Imparting training to undergraduate medical students and intern doctors in basic health care
 Orientation training of male and female health workers in various National Health Programmes
including RCH, Adolescent health services and immunization
 Skill based training to ASHAs
 Initial and periodic Training of paramedics in treatment of minor ailments
 Periodic training of Doctors and para medics through Continuing Medical Education, conferences,
skill development trainings
 All health staff of PHC must be trained in IMEP
Desirable
 There should be provision of induction training for doctors, nursing and paramedical staff
 Whenever new/higher responsibility is assigned or new equipment/technology is introduced, there
must be provision of training
 There must be mechanism for ensuring quality assurance in trainings by Training feedback and
Training effectiveness evaluation
 Appropriate placement for trained person should be ensured
 Trainings in minor repairs and maintenance of available equipment should be provided to the user
 Training of para medics in indenting, forecasting, inventory and store management
 Development of protocols for equipment (operation, preventive and breakdown maintenance)
Note:
1.
Trainings should commensurate with job responsibilities for each category of health personnel
2.
Since ECG machine is envisaged in PHCs hence lab technician or some other paramedic should
be trained in taking ECG
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BASIC LABORATORY AND DIAGNOSTIC SERVICES
Essential Laboratory services including
 Routine urine, stool and blood tests (Hb%, platelets count, total RBC, WBC, bleeding and clotting
time)
 Diagnosis of RTI/STDs with wet mounting, Grams stain, 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
Desirable
 Blood Cholesterol
 ECG
Validation of reports: periodic validation of laboratory reports should be done with external agencies
like District PHC/Medical college for Quality Assurance. Periodic calibration of Laboratory and PHC
equipment.
MONITORING AND SUPERVISION
Essential
 Monitoring and supervision of activities of Sub- Centre through regular meetings/periodic visits, by
LHV, Health Assistant Male and Medical Ofcer etc.
 Monitoring of all National Health Programmes by Medical Ofcer with support of LHV, Health
Assistant Male and Health educator.
 Monitoring activities of ASHAs by LHV and ANM (in her Sub centre area).

58
Services to be Provided in a
Sub-Centre (IPHS)

59
 SERVICES TO BE PROVIDED IN A SUB-CENTRE (IPHS)

Sub-centres are expected to provide promotive, preventive and few curative primary health care
services. Keeping in view the changing epidemiological situation in the country, both types of Sub-centres
should lay emphasis on Non-Communicable Diseases related services. Given the understanding of the
health Sub-centre as mainly providing outreach facilities, where most services are not delivered in the Sub-
centre building itself, the site of service delivery may be at following places:
 In the village: Village Health Sanitation and Nutrition Day/ Immunization session
 During house visits
 During house to house surveys
 During meetings and events with the community
 At the facility premises
It is desirable, that theSub-centre should provide minimum of six of hours of routine OPD services in
a day for six days in a week. Wherever two ANMs are provided, it shall be ensured that one of the ANMs is
available at the Sub-centre and the Sub-centre remains open for providing OPD services on all working
days. Only one of them may provide outreach services at a time.
The main differences in services to be provided by the two types of Sub-centres are:
 Type A: Shall provide all services as envisaged for the Sub-centre except the facilities for
conducting delivery will not be available here.
 Type B: They will provide all recommended services including facilities for conducting deliveries at
the Sub-centre itself. This Sub-centre will act as Maternal and Child Health (MCH) centre with basic
facilities for conducting deliveries and Newborn Care at the Sub centre.
Although the main focus shall be to promote institutional deliveries, however, the facilities for attending
to home deliveries shall remain available at both types of Subcentres.
The following is the consolidated list of services to be provided through two types of Sub-centres. The
services have been classied as Essential (Minimum Assured Services) or Desirable (that all
States/UTs should aspire to achieve).
I. Antenatal care:
Essential

Registration
 Early registration of all pregnancies, within rst 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. Suggested schedule for antenatal visits:
o 1st visit: Within 12 weeks—preferably as soon as pregnancy is suspected—for registration,
history and rst antenatal check-up
o 2nd visit: Between 14 and 26 weeks
o 3rd visit: Between 28 and 34 weeks
o 4th visit: Between 36 weeks and term
60
  Associated services like general examination such as height, weight, B.P., anemia, abdominal
examination, breast examination, Folic Acid Supplementation (in rst trimester), Iron & Folic Acid
Supplementation from 12 weeks, injection tetanus toxoid, treatment of anemia etc., (as per the
Guidelines for Antenatal care and Skilled Attendance at Birth by ANMs and LHVs).

 Recording tobacco use by all antenatal mothers.

 Minimum laboratory investigations like Urine Test for pregnancy conrmation, haemoglobin
estimation, urine for albumin and sugar and linkages with PHC for other required tests.

 Name based tracking of all pregnant women for assured service delivery.

 Identication of high risk pregnancy cases.

 Identication and management of danger signs during pregnancy.

 Malaria prophylaxis in malaria endemic zones for pregnant women as per the guidelines of
NVBDCP.

 Appropriate and Timely referral of such identied cases which are beyond her capacity of
management.

 Counseling on diet, rest, tobacco cessation if the antenatal mother is a smoker or tobacco user,
information about dangers of exposure to second hand smoke and minor problems during
pregnancy, advice on institutional deliveries, pre-birth preparedness and complication readiness,
danger signs, clean and safe delivery at home if called for, postnatal care & hygiene, nutrition, care
of newborn, registration of birth, initiation of breast feeding, exclusive breast feeding for 6 months,
demand feeding, supplementary feeding (weaning and starting semi solid and solid food) from 6
months onwards, infant & young child feeding and contraception.

 Provide information about provisions under current schemes and programmes like Janani
Suraksha Yojana.

 Identify suspected RTI/STI case, provide counseling, basic management and referral services.

 Counseling & referral for HIV/AIDS.

 Name based tracking of missed and left out ANC cases.

II. INTRA-NATAL CARE

Essential

 Promotion of institutional deliveries

 Skilled attendance at home deliveries when called for

 Appropriate and Timely referral of high risk cases which are beyond her capacity of management

61
ESSENTIAL FOR TYPE B SUB-CENTRE
 Managing labour using Partograph
 Identication and management of danger signs during labor
 Procient in identication and basic rst aid treatment for PPH, Eclampsia, Sepsis and prompt
referral of such cases as per Antenatal Care and Skilled Birth Attendance (SBA) Guidelines.
 Minimum 24 hours of stay of mother and baby after delivery at Sub-centre. The environment at the
Sub-centre should be clean and safe for both mother and baby.
III. POSTNATAL CARE:
Essential
 Initiation of early breast-feeding within one hour of birth.
nd
 Ensure post-natal home visits on 0, 3, 7, 14, 21, 28 and 42 day for deliveries at home and Sub-
centre (both for mother & baby) (7 visits).
 Ensure 3, 7, 14, 21, 28 and 42nd day visit for institutional delivery (both for mother & baby) cases (6
Visits).
 In case of Low Birth weight Baby (less than 2500 gm), additional visits are required.
 During post-natal visit, advice regarding care of the mother and care and feeding of the newborn
and examination of the newborn for signs of sickness and congenital abnormalities as per IMNCI
Guidelines and appropriate referral, if needed.
 Counseling on diet & rest, hygiene, contraception, essential newborn care, immunization, infant
and young child feeding, STI/RTI and HIV/AIDS.
 Name based tracking of missed and left out PNC cases.
Child Health
Essential
Essential Newborn Care [maintain the body temperature and prevent hypothermia [provision of
warmth/Kangaroo Mother Care (KMC)], maintain the airway and breathing, initiate breast feeding within one
hour, infection protection, cord care, and care of the eyes, as per the guidelines for Ante-Natal Care and
Skilled Attendance at Birth by ANMs and LHVs.

Post natal visits as mentioned under “Post natal Care”
 Counseling on exclusive breast-feeding for 6 months and appropriate and adequate
complementary feeding from 6 months of age while continuing breastfeeding. (As per National
Guidelines on Infant and Young Child Feeding, 2006, by Ministry of WCD, Government of India).
 Assess the growth and development of the infants and under 5 children and make timely referral.
 Immunization Services: Full Immunization of all infants and children against vaccine preventable
diseases as per guidelines of Government of India

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JANANI SURAKSHA YOJANA
Janani Suraksha Yojana (JSY) is a safe motherhood intervention under the National Rural Health
Mission (NRHM) being implemented with the objective of reducing maternal and neo-natal mortality by
promoting institutional delivery among the poor pregnant women. This scheme integrates cash assistance
with delivery and post-delivery care.
While the scheme would create demand for institutional delivery, it would be necessary to have
adequate number of 24X7 delivery services centre, doctors, mid-wives, drugs etc. at appropriate places.
Mainly, this will entail linking each habitation (village or a ward in an urban area) to a functional health centre-
public or accredited private institution where 24X7 delivery services would be available.

 Associate an ASHA or a health link worker to each of these functional health centre.

 It should be ensured that ASHA keeps track of all expectant mothers and newborn. All expectant
mother and newborn should avail ANC and immunization services, if not in health centres, at least
on the monthly health and nutrition day, to be organized in the Anganwadi or sub centre.

 Each pregnant woman is registered and a micro birth plan is prepared.

 Each pregnant woman is tracked for ANC

 For each of the expectant mother, a place of delivery is pre-determined at the time of registration
and the expectant mother is informed

 A referral centre is identied and expectant mother is informed

 ASHA and ANM to ensure that adequate fund is available for disbursement to expectant mother

 ASHA takes adequate steps to organize transport for taking the women to the pre-determined
health institution for delivery

 ASHA assures availability of cash for disbursement at the health centre and she escorts pregnant
women to the pre-determined health centre

 ASHA package in the form of cash assistance for referral transport, cash incentive and
transactional cost to be provided as per guidelines
JANANI SHISHU SURAKSHA KARYAKRAM (JSSK)

 JSSK launched on 1st of June of 2011 is an initiative to assure free services to all pregnant women
and sick neonates accessing public health institutions.

 The scheme envisages free and cashless services to pregnant women including normal deliveries
and caesarian section operations and also treatment of sick newborn (up to 30 days after birth) in all
Government health institutions across State/UT.

 This initiative supplements the cash assistance given to pregnant women under the JSY and is
aimed at mitigating the burden of out of pocket expenditure incurred by pregnant women and sick
newborns.

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ENTITLEMENTS FOR PREGNANT WOMEN
 Free and Zero expense delivery and Caesarian Section
 Free Drugs and Consumables
 Free Diagnostics (Blood, Urine tests and Ultrasonography etc. as required)
 Free diet during stay in the health institutions (up to 3 days for normal deliveries and upto 7 days for
caesarian deliveries)
 Free provision of the Blood
 Free transport from home to health institutions, between facilities in case of referrals and drop back
from institutions to home
 Exemption from all kinds of user charges
ENTITLEMENTS FOR SICK NEWBORN TILL 30 DAYS AFTER BIRTH
 Free and zero expense treatment
 Free Drugs and Consumables
 Free Diagnostics
 Free provision of the Blood
 Free transport from home to health institutions, between facilities in case of referrals and drop back
from institutions to home
 Exemption from all kinds of user charges
 Vitamin A prophylaxis to the children as per National guidelines
 Prevention and control of childhood diseases like malnutrition, infections, ARI, Diarrhea, Fever,
Anemia etc. including IMNCI strategy
 Name based tracking of all infants and children to ensure full immunization coverage
 Identication and follow up, referral and reporting of Adverse Events Following Immunization
(AEFI)
 Family Planning and Contraception
Essential
 Education, Motivation and counseling to adopt appropriate Family planning methods
 Provision of contraceptives such as condoms, oral pills, emergency contraceptives, Intra Uterine
Contraceptive Devices (IUCD) insertions (wherever the ANM is trained in IUCD insertion)
 Follow up services to the eligible couples adopting any family planning methods (terminal/ spacing)
SAFE ABORTION SERVICES (MTP)
Essential
 Counseling and appropriate referral for safe abortion services (MTP) for those in need.
 Follow up for any complication after abortion/ MTP and appropriate referral if needed

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CURATIVE SERVICES
Essential
 Provide treatment for minor ailments including fever, diarrhea, ARI, worm infestation and First Aid
including rst aid to animal bite cases (wound care, tourniquet (in snake bite) assessment and
referral)
 Appropriate and prompt referral
Desirable
 Provide treatment as per AYUSH as per the local need. ANMs and MPW (M) be trained in basic
AYUSH drugs
 Once a month clinic by the PHC medical ofcer. LHV, HWM and ANM should be available for
providing assistance
ADOLESCENT HEALTH CARE
Desirable
 Education, counselling and referral
 Prevention and treatment of Anemia
 Counselling on harmful effects of tobacco and its cessation
SCHOOL HEALTH SERVICES
Essential
 Screening, treatment of minor ailments, immunization, de-worming, prevention and management
of Vitamin A and nutritional deciency anemia and referral services through xed day visit of school
by existing ANM/MPW
 Staff of Sub-centre shall provide assistance to school health services as a member of team
CONTROL OF LOCAL ENDEMIC DISEASES
Essential
 Assisting in detection, Control and reporting of local endemic diseases such as malaria, Kala Azar,
Japanese encephalitis, Filariasis, Dengue etc
 Assistance in control of epidemic outbreaks as per programme guidelines
DISEASE SURVEILLANCE, INTEGRATED DISEASE SURVEILLANCE PROJECT (IDSP)
Essential
 Surveillance about any abnormal increase in cases of diarrhea/dysentery, fever with rigors, fever
with rash, fever with jaundice or fever with unconsciousness and early reporting to concerned PHC
as per IDSP guidelines.
 Immediate reporting of any cluster/outbreak based on syndromic surveillance.
 High level of alertness for any unusual health event, reporting and appropriate action.
 Weekly submission of report to PHC in 'S' Form as per IDSP guidelines.

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WATER AND SANITATION
Desirable
 Disinfection of drinking water sources.
 Promotion of sanitation including use of toilets and appropriate garbage disposal.
OUT REACH/FIELD SERVICES
VILLAGE HEALTH SANITATION AND NUTRITION DAY (VHSND)
VHSND should be organised twice in a month in each village with the help of Medical Ofcer, Health
Assistant Female (LHV) of PHC, HWM, HWF,ASHA, AWW and their supervisory staff, PRI, Self Help
Groups etc. The number of VHNDs should be enough to reach every habitation/Anganwadi center at least
once in a month. The ANM is accountable for these services, with the male worker also taking a due share of
the work, and being in charge of logistics and organisation, especially vaccine logistics. Participation of
Anganwadi workers, ASHAs and community volunteers would be essential for mobilization of beneciaries
and local organizational support.
Each Village Health Sanitation and Nutrition Day should last for at least four hours of contact time
between ANMs, AWWs, ASHAs and the beneciaries.
The services to be provided at VHSND are listed below:
Essential
 Early registration and Antenatal care for pregnant women – as per standard treatment protocol for
the SBA.
 Immunization and Vitamin A administration to all under 5 children- as per immunization schedule.
 Coordination with ICDS programme for Supplementary nutritional services, health check up and
referral services, health and nutrition education, immunization for children below 6 years, Pregnant
& Lactating Mother and health and nutrition education for all women in the age group (15 to 45
years).
 Family planning counseling and distribution of contraceptives.
 Symptomatic care and management of persons with minor illness referred by ASHAs/AWWs or
coming on their own accord.
 Health Communication to mothers, adolescents and other members of the community who attend
the VHND session for whatever reason.
 Meet with ASHAs and provide training/support to them as needed.
 Registration of Births and Deaths.
Desirable
 Symptom based care and counseling with referral if needed for STI/RTI and for HIV/AIDS
suspected cases.
 Disinfection of water sources and promotion of sanitation including use of toilets and appropriate
garbage disposal.

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HOME VISITS
Essential
 For skilled attendance at birth- where the woman has opted or had to go in for a home delivery.
 Post natal and newborn visits – as per protocol.
 To check out on disease incidences reported to Health Worker or he/she comes across during
house visits especially where there is a notied disease. Notify the M.O. PHC immediately about
any abnormal increase in cases of diarrhea / dysentery, fever with rigors, fever with rash, accid
paralysis of acute onset in a child <15 years (AFP), Wheezing cough, Tetanus, fever with jaundice
or fever with unconsciousness, minor and serious AEFIs which she comes across during her home
visits and take the necessary measures to prevent their spread.
Desirable
 Visits to houses of eligible couples who need contraceptive services, but are not currently using
them e.g. couples with children less than three years of age, where women are married and less
than 19 years of age, where the family is complete etc.
 Follow up of cases who have undergone Sterilization and MTP, as per protocols especially those
who cannot come to the facility.
 Visits to community based DOTS providers, leprosy depot holders where this is needed.
 Visits to support ASHA where further counseling is needed to persuade a family to utilize required
health services e.g., immunization dropouts, antenatal care dropouts, TB defaulter etc.
 To take blood slides/do RDK test in cases with fever where malaria is suspected.
HOUSE-TO-HOUSE SURVEYS
These surveys would be done annually, preferably in April. Some of the diseases would require special
surveys- but at all times not more than one survey per month would be expected. Surveys would be done
with support and participation of ASHAs, Anganwadi Workers, community volunteers, panchayat members
and Village Health Sanitation and Nutrition Committee members.
The Male Health worker would take the lead and be accountable for the organization of these surveys and
the subsequent preparation of lists and referrals.
The surveys would include.
Essential
 Age and sex of all family members.
 Assess and list eligible couples and their unmet needs for contraception.
 Identify persons with skin lesions or other symptoms suspicious of leprosy and refer, essential in
high leprosy prevalence blocks.
 Identify persons with blindness, list and refer, Identify persons with hearing impairment/ deafness,
list and refer.
 Annual mass drug administration in larial endemic areas.

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Desirable
 Identify persons with disabilities, list and refer and call for counseling where needed.
 Identify and list senior citizens who need special care and support.
 Identify persons with mental health problems and Epilepsy, list and refer.
 In high endemic areas-survey for fever suspicious of kala- azar, for epidemic management of
malaria, for detection of uorosis affected cases etc.
 Any other obvious disease/disorder, list and refer.
COMMUNITY LEVEL INTERACTIONS
Essential
 Focus group discussions for information gathering and health planning.
 Health Communication especially as related to National Health programmes through attending
Village Health Sanitation and Nutrition Committee meetings, ASHA local review meetings and
meetings with panchayat members/sarpanch, Self Help Groups, women's groups and other BCC
activities.
COORDINATION AND MONITORING
 Coordinated services with AWWs, ASHAs, Village Health Sanitation and Nutrition Committee PRI
etc.
NATIONAL HEALTH PROGRAMMES
COMMUNICABLE DISEASE PRGRAMME
a.
National AIDS Control Programme (NACP):
Essential
 Condom promotion & distribution of condoms to the high risk groups.
 Help and guide patients with HIV/AIDS receiving ART with focus on adherence.
 IEC activities to enhance awareness on preventive measures about STIs and HIV/AIDS, PPTCT
services and HIV-TB coordination.
Desirable
 Linkage with Microscopy Centre for HIV-TB coordination.
 HIV/STI Counseling, Screening and referral in Type B Sub-centres (Screening in Districts where
the prevalence of HIV/AIDS is high).
b.
National Vector Borne Disease Control Programme (NVBDCP):
Essential
 Collection of Blood slides of fever patients.
 Rapid Diagnostic Tests (RDT) for diagnosis of Pf malaria in high Pf endemic areas.
 Appropriate anti-malarial treatment.

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  Assistance for integrated vector control activities in relation to Malaria, Filaria, JE, Dengue, Kala-
Azar etc. as prevalent in specic areas. Prevention of breeding places of vectors through IEC and
community mobilization.
 Where laria is endemic, identication of cases of lymphoedema/elephantiasis and hydrocele and
their referrals to PHC/CHC for appropriate management. The disease specic guidelines issued by
NVBDCP are to be followed.
 Annual mass drug administration with singly dose of Diethyl carbamazine (DEC) to all eligible
population at risk of lymphatic lariasis.
 Promotion of use of insecticidal treated nets, wherever supplied.
 Record keeping and reporting as per programme guidelines.
c.
National Leprosy Eradication Programme (NLEP):
Essential
 Health education to community regarding signs and symptoms of leprosy, its complications,
curability and availability of free of cost treatment.
 Referral of suspected cases of leprosy (person with skin patch, nodule, thickened skin, impaired
sensation in hands and feet with muscle weakness) and its complications to PHC.
 Provision of subsequent doses of MDT and follow up of persons under treatment for leprosy,
maintain records and monitor for regularity and completion of treatment.
d.
Revised National Tuberculosis Control Programme (RNTCP):
Essential
 Referral of suspected symptomatic cases to the PHC/Microscopy centre.
 Provision of DOTS at Sub-centre, proper documentation and follow-up.
 Care should be taken to ensure compliance and completion of treatment in all cases.
 Adequate drinking water should be ensured at Sub-centre for taking the drugs.
Desirable
 Sputum collection centers established in Sub-centre for collection and transport of sputum samples
in rural, tribal, hilly & difcult areas of the country where Designated Microscopy Centres are not
available as per the RNTCP guidelines.
Non-communicable Disease (NCD) Programmes
Note: These services are to be provided at both types of Sub-centres.
a.
National Programme for Control of Blindness (NPCB):
Essential
 Detection of cases of impaired vision in house to house surveys and their appropriate referral. The
cases with decreased vision will be noted in the blindness register.
 Spreading awareness regarding eye problems, early detection of decreased vision, available
treatment and health care facilities for referral of such cases. IEC is the major activity to help identify
cases of blindness and refer suspected cataract cases.

69
Desirable
 The cataract cases brought to the District Hospital by MPW/ANM/and ASHAS.
 Assisting for screening of school children for diminished vision and referral.
b.
National Programme for Prevention and Control of Deafness (NPPCD):
Essential
 Detection of cases of hearing impairment and deafness during House to house survey and their
appropriate referral.
 Awareness regarding ear problems, early detection of deafness, available treatment and health
care facilities for referral of such cases.
 Education of community especially the parents of young children regarding importance of right
feeding practices, early detection of deafness in young children, common ear problems and
available treatment for hearing impairment/deafness.
c.
National Mental Health Programme:
Essential
 Identication and referral of common mental illnesses for treatment and follow them up in
community.
 IEC activities for prevention and early detection of mental disorders and greater participation/role of
Community for primary prevention of mental disorders.
d.
National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular
Diseases and Stroke:
Essential
 IEC Activities to promote healthy lifestyle sensitize the community about prevention of Cancers,
Diabetes, CVD and Strokes, early detection through awareness regarding warning signs and
appropriate and prompt referral of suspect cases.
e.
National Iodine Deciency Disorders Control Programme:
Essential
 IEC Activities to promote consumption of iodized salt by the community. Testing of salt for presence
of Iodine through Salt Testing Kits by ASHAs.
f.
In Fluorosis affected (Endemic) Areas:
Essential
 Identify the persons at risk of Fluorosis, suffering from Fluorosis and those having deformities due
to Fluorosis and referral.
Desirable
 Line listing of reconstructive surgery cases, rehabilitative intervention activities and referral
services.
 Focused behaviour change communication activities to prevent Fluorosis.

70
g. National Tobacco Control Programme:

Essential
 Spread awareness and health education regarding ill effects of tobacco use especially in pregnant
females and Non-Communicable diseases where tobacco is a risk factor e.g. Cardiovascular
disease, Cancers, chronic lung diseases.
 Display of mandatory signage of “No Smoking” in the Sub-centre.

Desirable
 Counseling for quitting tobacco.
 Awareness to public that smoking is banned in public places and sale of tobacco products is banned
to minors (less than 18 years) as well as within 100 yards of schools and educational institutions.
 Spread awareness regarding law on smoke free public places.
h.
Oral Health Programme

Desirable
 Health education on oral health and hygiene especially to antenatal and lactating mothers, school
and adolescent children.
 Providing rst aid and referral services for cases with oral health problems.
I. Disability Prevention:

Desirable
 Health education on Prevention of Disability.
 Identication of Disabled persons during annual house to house survey and their appropriate
referral.
j. National Programme for Health Care of Elderly:

Desirable
 Counseling of Elderly persons and their family members on healthy ageing.
 Referral of sick old persons to PHC.
Promotion of Medicinal Herbs
Desirable
 Locally available medicinal herbs/plants should be grown around the Sub-centre as per the
guidelines of Department of AYUSH.
Record of Vital Events
Essential
 Recording and reporting of vital events including births and deaths, particularly of mothers and
infants to the health authorities.

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COMMISSIONER OF HEALTH & FAMILY WELFARE,
ANDHRA PRADESH, HYDERABAD