COMMUNITY HEALTH CENTRE , LAMBI

The Community Health Centres (CHCs) constitute the secondary level of health care, were designed to
provide referral as well as specialist health care to the rural population. Indian Public Health Standards
(IPHS) for CHCs have been prescribed under National Rural Health Mission (NRHM) since early 2007
Page | 1
to provide optimal specialized care to the community and achieve and maintain an acceptable standard
of quality of care. As setting standards is a dynamic process, the need was felt to update the IPHS
keeping in view the changing protocols of existing National Health Programmes, development of new
programmes especially for non communicable diseases and prevailing epidemiological situation in the
country and different States/UTs of the country; accordingly the revision has been carried out. These
standards would act as benchmarks and help monitor and improve the functioning of the CHCs.

Community Health Centres (CHCs), constituting the First Referral Units (FRUs) and the Sub-district
and District Hospitals. The CHCs were designed to provide referral health care for cases from the
Primary Health Centres level and for cases in need of specialist care approaching the centre directly. 4
PHCs are included under each CHC thus catering to approximately 80,000 populations in
tribal/hilly/desert areas and 1,20,000 population for plain areas. CHC is a 30-bedded hospital providing
specialist care in Medicine, Obstetrics and Gynecology, Surgery, Paediatrics, Dental and AYUSH.
There are 4535 CHCs functioning in the country as on March 2010 as per Rural Health Statistics
Bulletin 2010. These centres are however fulfilling the tasks entrusted to them only to a limited extent.
The launch of the National Rural Health Mission (NRHM) gives us the opportunity to have a fresh look
at their functioning.

The community health centre Lambi is located in district Muktsar sahib . it covers nearby villages with
population 85,000 individuals approximately . The senior medical officer of CHC Lambi is Satish
Kumar Goyal . It works under Health and welfare department Punjab. It provides secondary level of care
and PHCs refer complicated cases here. The facilities of medicine, gynae , surgery , emergency , dental
are available here
 MISSION/VISION STATEMENT OF CHC LAMBI

The Punjab Health Systems Corporation (PHSC) has summed up the World Bank Aided, Second State
Page | 2 Health Systems Development Project activities in the year 2004-2005. Now PHSC is in the process of
consolidating gains under the project.

PHSC has further decided to diversity its activities as follows:-

PHSC can be declared as a Nodal Agency and CHC Lambi works under it na dworks as follows:

a) Identification and Implementation of Primary Health Care Project. Contract for consultancy has
been signed by PHSC with Faith Health Group on 29.9.03.
b) Implementation of Regional Cancer Centre in the State. PHSC has already prepared a project for
Civil Hospital Jalandhar.
c) Fund Channelizing Agency for assistance from GOI and abroad as mother NGO.
d) Asses Maintenance Agency for Medical Colleges, Hospitals, Dispensaries, ESI hospitals and
Dispensaries.
e) Carrying out various health sector reforms like;

 Implementation of Health Insurance Scheme in the State.

 Public Private Mix through collaborations and joint ventures.
 For policy frame work, maintenance of over all State Health Statistics on the pattern of
National Health Accounts.
 Taking up the assignments as an Independent Consultants, Negotiations are being done
for taking up of Waste Management Consultancy in other States, which are implementing
the project.

f) Focused Approach on Secondary Health Care for sustainability in implementation of following

introduced programmes.
 Health Management Information System
 Quality Assurance
 Waste Management Strategies
 Disease Surveillance
 Referral Systems

GOALS OF CHC LAMBI

 CHC has been envisaged as only one type and will act both as Block level health
administrative unit and gatekeeper for referrals to higher level of facilities.
 The revised IPHS (CHC) has considered the services, infrastructure, manpower, equipment and
drugs in two categories of Essential (minimum assured services) and Desirable (the ideal level
services which the states and UT shall try to achieve).
  All essential services as envisaged in the CHC should be made available, which includes routine
and emergency care in Surgery, Medicine, Obstetrics and Gynaecology, Paediatrics, Dental and
AYUSH in addition to all the National Health Programmes.

Page | 3
 Standards of services under existing programmes were updated and standards added for newly
developed non communicable disease programmes based on the inputs from various programme
divisions. Standards for Newborn stabilization unit, MTP facilities for second trimester
pregnancy (desirable), The Integrated Counselling and Testing Centre (ICTC), Blood storage and
link Anti Retroviral Therapy centre have been added.

OBJECTIVES OF CHC LAMBI:

 To provide optimal expert care to the community.
 To achieve and maintain an acceptable standard of quality of care.
 To ensure that services at CHC are commensurate with universal best practices and are
responsive and sensitive to the client needs/expectations.
 To engage specialized agencies or individuals in the relevant disciplines, directly or from
external sources for the efficient and expeditious conduct of any of the functions detailed above;
and
 To provide immediate treatment in case of emergency and for un-accompanied patients.
STRATEGIES OF CHC LAMBI
CORE STRATEGIES:
i. Train and enhance the capacity of Panchayati Raj institutions to own, control and manage
public health services
ii. Promote access to improved healthcare at household level through the village-level worker
(Accredited Social Health Activist)
iii. Health plan for each village through the village health committee of the Panchayat
iv. Strengthening sub-centre through better human resource development, clear quality standards,
better community standards, better community support and an untied funds to enable local
planning and action and more Multipurpose workers
v. Strengthening existing primary health centres through better staffing and human
resource development policy, clear quality standards, better community support
and an untied fund to enable the local management committee to achieve these
standards
vi. Provision of 30-50 bedded CHC per lakh population for improved curative care to
a normative standard
vii. Preparation and implementation of an inter-sector district health plan prepared
by district health mission, including drinking water supply, sanitation, hygiene
and nutrition
 viii. Integrating vertical health and family welfare programmes at national, state,
district and block levels
ix. Technical support to national, state and district health mission, for public health management
x. Strengthening capacities for data collection, assessment and review for evidence base
Page | 4 planning, monitoring and supervision
xi. Formulation of transparent policies to deploy human resources to health
xii. Developing capacities for preventive healthcare at all levels to promote healthy lifestyles,
reduction in the consumption of tobacco and alcohol, etc.
xiii. Promoting the non-profit sector particularly in under-served areas
SUPPLEMENTARY STRATEGIES:
i. Regulation for private sector including the informal rural medical practitioners to
ensure the availability of quality service to citizens at a reasonable cost
ii. Promotion of public-private partnerships to achieve public health goals
iii. Mainstream Indian system of medicine (AYUSH) to revitalize local health traditions
iv. Reorient medical education to support rural health issues including regulation of
medical care to medical ethics

v. Effective and visible risk pooling and social health insurance to provide health
security to the poor by ensuring accessible, affordable, accountable and good
quality hospital care

PHYSICAL STRUCTURE OF CHC LAMBI:

The infrastructure of community health centre Lambi is divided into two storeys and located in a village
Lambi . The ground floor includes reception and other OPDs with Senior medical officer room ,
Laboratories and Arash clinic . The first floor has male and female ward , computer room , Ictc centre ,
labour room , staff nurse room , nursing superintendant room Kmc room , NICU and gynae OT . The
second floor has dengue ward , malaria ward , Birth and death registration room , operation theatre
complex .
Page | 5

ORGANISATION SET UP AT CHC

The CHC should have 30 indoor beds with one Operation theatre, labour room, X-ray, ECG and
laboratory facility. In order to provide these facilities, following are the guidelines.

A. Location of the centre: All the guidelines as below under this sub-head may be
applicable only to centres that are to be newly established and priority is to be
given to operationalise the existing CHCs.

 To the extent possible, the centre should be located at the centre of the block headquarter in
order to improve access to the patients.
 The area chosen should have the facility for electricity, all weather road communication,
adequate water supply, telephone etc.
 It should be well planned with the entire necessary infrastructure. It should be well lit and
ventilated with as much use of natural light and ventilation as possible.
 CHC should be away from garbage collection, cattle shed, water logging area, etc.
B. Disaster Prevention Measures: (For all new upcoming facilities in seismic
zone 5 or other disaster prone areas).

Building structure and the internal structure should be made disaster proof especially earthquake proof,
flood proof and equipped with fire protection measures.

 Earthquake proof measures: Structural and non-structural elements should be built in to

withstand quake as per geographical/state govt. guidelines. Non-structural features like fastening
the shelves, almirahs, equipment etc are even more essential than structural changes in the
buildings. Since it is likely to increase the cost substantially, these measures may especially be
taken on priority in known earthquake prone areas. CHC should not be located in low lying area
to prevent flooding. CHC should have dedicated, intact boundary wall with a gate. Name of the
CHC in local language should be prominently displayed at the entrance which is readable in
night too.
 Fire fighting equipment: Fire extinguishers, sand buckets, etc. should be available and
maintained to be readily available when needed. Staff should be trained in using fire fighting
 equipment.
Each CHC should develop a fire fighting and fire exit plan with the help of Fire Department.
Regular mock drills should be conducted. All CHCs should have a Disaster Management Plan in
line with the District Disaster management Plan. All health staff should be trained and well
conversant with disaster prevention and management aspects Surprise mock drills should be
Page | 6 conducted at regular intervals. After each drill the efficacy of the Disaster Plan, preparedness of
the CHC, and the competence of the staff should be evaluated followed by necessary changes in
the Plan and training of the staff.
The CHC should be, as far as possible, environment friendly and energy efficient. Rain-Water
harvesting, solar energy use and use of energy-efficient CFL bulbs/equipment should be
encouraged. Provision should be made for horticulture services including herbal garden . The
building should have areas/space marked for the following:

 Entrance Zone

Signage
 Prominent display boards in local language
 providing information regarding the services
 available and the timings of the institute.

 Directional And layout signages for all the departments and utilities(toilets, drinking water etc.)
shall be appropriately displayed for easy access. All the signages shall be bilingual and pictorial.

 Citizen charter shall be displayed at OPD and Entrance in local language including patient’s
rights and responsibilities.

 On-the-way signages of the CHC & location should be Displayed on all the approach roads.
 Safety, hazards and caution signs shall be displayed prominently at relevant places, e.g. radiation
hazards for pregnant woman in X-Ray.
 Fluroscent Fire-Exit signages at strategic locations.
c. Barrier free access environment for easy access to non-ambulant
(wheel-chair stretcher), semi-ambulant, visually disabled And elderly
Persons as per “Guidelines And Space Standards for barrier-free built
environment for Disabled and Elderly Persons” of Government of India.
 Ramp as per specification, Hand-railing, proper lightning etc must be provided in all
 health facilities and retrofitted in older one which lack the same.
 Registration cum Inquiry counters.
 Name of Department and doctor, timings and user fees/charges shall be displayed.
 Layout of the Out Patient Department shall follow the
 functional flow of the patients: e.g.
Enquiry→ Registration→ Waiting→ Sub Waiting→
Clinic→ Dressing room/Injection Room→ Billing→
Diagnostics (lab/X-ray)→pharmacy→ Exit
d. Clinics for Various Medical Disciplines : These clinics include general
medicine, general surgery, dental, obstetric and gynaecology, welfare.
Separate cubicles for general medicine and surgery with separate area for
 internal examination (privacy) can be provided if there are no separate
rooms for each. The cubicles for consultation and examination in all
clinics should provide for doctor’s chair, With couch and equipment for
examination.
 Room shall have, for the admission of light And windows and fan lights, opening directly to the
Page | 7 external air or into an open verandah.
 The windows should be in two opposite walls.
e. Family Welfare Clinic : The clinic should provide and curative
facilities for maternal, child
health, school health and health education. Importance increasingly hospital should be
informed of personal and environmental hygiene, clean habits, need for taking preventive
measures against epidemics, family planning, non-communicable diseases etc. Treatment room
in this clinic should act as operating room for IUCD insertion and to Obstetric & Gynaecology.
Family Welfare counselling room should be provided.

Waiting room for patients.

The Pharmacy should be located in an area conveniently accessible from all clinics. The
dispensary and compounding room should have two dispensing windows, compounding
counters and shelves. The pattern of arranging the counters and shelves shall depend on the size
of the room. The medicines which require cold storage and blood required for operations and
emergencies may be kept in refrigerators.
f. Emergency Room/Casualty: At the moment, the emergency cases are
being attended in OPD during OPD hours and in inpatient units
afterwards. It is recommended to have a separate earmarked emergency
area to be located near the entrance of hospital preferably having 4 rooms
(one for doctor, one for minor OT, one for plaster/dressing) and one for
patient observation (At least 4 beds).
g. Treatment Room

 Minor OT
 Injection Room and Dressing Room
 Observation Room
h. Wards: Separate for Males and Females
 Nursing Station : The nursing station shall be centered such that it serves all the clinics
from that place. The nursing station should be spacious enough to accommodate a
medicine chest/a work counter (for preparing dressings, medicines), hand washing
facilities, sinks, dressing tables with screen in between and colour coded bins (as per
IMEP guidelines for community health centres). It should have provision for Hub
cutters and needle destroyers.
 Examination and dressing table.
 Patient Area
o Enough space between beds.
o Toilets; separate for males and females.
o Separate space/room for patients needing isolation.
i. Ancillary rooms
o Nurses rest room.
 o There should
be an area separating OPD and Indoor facility.
j. Operation theatre/Labour room
o Patient waiting Area.
o Pre-operative and Post-operative (recovery) room.
o Staff area.
Page | 8 o Changing room separate for males and females.
o Storage area for sterile supplies.
o Operating room/Labour room.
o Scrub area.
o Instrument sterilization area.
o Disposal area
k. New born Care Stabilization Unit

l. Public utilities: Separate for males and female; for patient as well as for paramedical & Medical
staff. Disabled friendly, WC with wash basins as specified under Guidelines for disabled friendly
environment should be provided.

Physical Infrastructure for Support Services

m. Central Steritization Supply Department (CSSD): Sterilization and Sterile storage.

Laundry: Storage should be separate for dirty linen and clean linen.
Outsourcing is recommended after appropriate training of washer man regarding segregation and
separate treatment for infected and non-infected linen.

n. Engineering Services: Electricity/telephones /water/civil Engineering may be outsourced.

Maintenance of proper sanitation in toilets and other public utilities should be given utmost
attention. Sufficient funding for this purpose must be kept and the services may be outsourced.
o. Water Supply : Arrangements shall be made to supply 10,000 litres of potable water per day to
meet all the requirements (including laundry) except fire fighting. Storage capacity
for 2 days requirements should be on the basis of the above consumption. Round the clock water supply
shall be made available to all wards and departments of the hospital. Separate reserve emergency
overhead tank shall be provided for operation theatre. Necessary water storage overhead tanks with
pumping/boosting arrangement shall be made. The laying and distribution of the water supply system
shall be according to the provisions of IS: 2065-1983 (a BIS standard). Cold and hot water supply piping
should be run in concealed form embedded into wall with full precautions to avoid any seepage. Geyser
in O.T./L.R. and one in ward also should be provided. Wherever feasible solar installations should be
promoted.

p. Emergency Lighting : Emergency portable/ fixed light units should also be provided in the
wards and departments to serve as alternative source of light in case of power failure. Generator
back-up should be available in all facilities. Generator should be of good capacity. Solar energy
wherever feasible may be used.
q. Generator : 5 KVA with POL for Immunization Cold Chain maintenance.
r. Telephone: minimum two direct lines with intercom facility should be available.
ADMINISTRATIVE ZONE
 Separate rooms should be available for:

 Office
 Stores
Residential Zone
Page | 9
 Minimum 8 quarters for Doctors.
 Minimum 8 quarters for staff nurses/ paramedical staff.
 Minimum 2 quarters for ward boys.
 Minimum 1 quarter for driver.
If the accommodation can not be provided due to any reason, then the staff may be paid house rent
allowance, but in that case they should be staying in near vicinity of CHC so that they are available for
24 x 7 in case of need.

FUNCTION & SPACE REQUIREMENT FOR COMMUNITY HEALTH

CENTRE
It is suggested considering the land cost & availability of land, CHC building may be constructed in two
floors.

Function & Space Requirement for Different Zones

SIZE FOR EACH TOTAL AREAS IN
ZONE FUNCTIONS SUB-FUNCTION SQ MTRS

3.2 X 3.2 X 2
counter/Formulation/Drug

Queue area outside 10.5 Sq Mtrs

storage) Public utilities &
storage, Pharmacy (Issue

registration room 3.5 X 3

circulation space

Pharmacy cum store 6.4

Entrance Zone

X 3.2 20.48 Sq Mtrs

Pharmacy cum store for 20.48 Sq Mtrs

AYUSH 6.4 X 3.2

Space for 4 General

Examination & Workup Doctor

(Examination Room, sub Room 3.2 X 3.2 X 4 40.96 Sq Mtrs

Ambulatory Zone (OPD)

Space for 2 AYUSH

waiting), Consultation doctors

(consultation room
Toilets, Room 3.2 X 3.2 X 2 20.48 Sq Mtrs

sub waiting) Nursing 8 specialist room with

station attach
 (Nurses desk, clean
utility, toilets = 3.7 X 3.2 X 8 94.72 Sq Mtrs

Page | 10
 Treatment room 3.7 X
dirty utility, treatment 3.2 11.84 Sq Mtrs

rooms, injection & Refraction room 3.2 X

dressing 3.2 10.24 Sq Mtrs
room), Cold Chain, Nursing Station 6.4 X
Vaccines 3.2 20.48 Sq Mtrs
Page | 11
and Logistics area, ECG Casualty 6.4 X 6.4 40.96 Sq Mtrs
(with sub waiting)
Casualty/ Dress Room 3.2 X 3.2 10.24 Sq Mtrs
Emergency, public Injection Room 3.2 X
utilities, 3.2 10.24 Sq Mtrs
Female injection room
circulation space 3.2 X 3.2 10.24 Sq Mtrs

Public Utility/Common 9.5 Sq Mtrs

Toilets

Waiting Area 31.5 Sq Mtrs

Cold Chain Room 3.5 x
3 10.5 Sq Mtrs

Vaccine and Logistics

Room 3.5 x 3 10.5 Sq Mtrs

Pathology (Optional) Area specification is 180 Sq Mtrs

Laboratory, sample Recommended
collection, bleeding
room,
washing disinfectants
storage, sub waiting,
Imaging
(radiology, radiography,
ultra-
sound), Preparation,
room,
Diagnostic Zone

change room, toilet,

control,
Dark room, treatment
room,
 sub waiting, public
utilities

Nursing station 6.4 X

Nursing station (Nurse 6.4 40.96 Sq Mtrs
Page | 12 desk,clean utility,
treatment 4 wards each with 6 beds 153.76 Sq Mtrs
room, pantry, store, ( 2 male wards & 2
sluice female
wards) size (6.2 X 6.2 )
room, trolly bay) patient X 4 79.36 Sq Mtrs
Intermediate Zone (inpatient Nursing units)

4 private room (2 each

area (bed space, toilets, for
Day space, Isolation male & females) with
Space) toilets
Ancillary rooms
(Doctor’s 6.2 X 3.2 X 4 2 39.68 Sq Mts
isolation rooms with
rest room, Nurses duty toilet
(one each for male &
room, Public utilities, female)

circulation space. 6.2 X 3.2 X 2

Critical Zone Patient area

(Operational (Preparation, Area specification is 240 Sq Mtrs

Theater/Labour room Preanaesthesia, post Recommended

operative resting) Staff
area
(Changing Resting)
Supplies
area (trolley bay,
equipment
storage, sterile storage)
OT/
Large area
(Operating/Labour

room, scrub, instrument

 sterilization, Disposal)
public

utilities, circulation
Page | 13 space

Area specification is
Dietary (Dry Store, Day Services like Electrical
Store, Preparation,
Cooking, engineering /Mechanical recommended
Delivery, pot wash,
Utensil engineering & Civil
wash, Utensil store, engineering can be
trolley privately
park) C.S.S.D. (Receipt,
wash, hired to avoid permanent
assembly, sterilization, space in the CHC
sterile building

storage, Issue) Laundry

(Receipt, weigh,
sluice/wash,
Hydro extraction,
tumble,

calender, press) Laundry

(clean storage, Issue),

Civil engineering
(Building
maintenance,
Horticulture,

water supply, drainage

and sanitation),
Electrical
Service Zone

engineering (sub station

&

generation, Illumination,
 ventilation), Mechanical

engineering, Space for

other services like gas
store,
Page | 14
telephone, intercom, fire
protection, waste
disposal,

Mortuary.

General Administration, Area specification is 60 Sq Mtrs

general store, public
Administrative

utilities Recommended

circulation space
zone

Total Circulation Area/Corridors 191.15 Sq Mtrs

Total Area 1503.32q Mtrs

Capacity Building
Training of all cadres of worker at periodic intervals is an essential component. Multi
skill training for Doctors, Staff Nurses and paramedical workers is recommended

BED STRENGTH

Sanctioned beds Functional beds

30 6

GROUND FLOOR
 EMERGENCY WING

Page | 15

MAIN LAB OPD GYNAE,

ARASH CLINIC ,
SURGERY , EYE ,
DENTAL , GENERAL
STAFF TOILET

TB LAB

SENIOR MEDICAL OFFICER

WATER

DISPENSARY TOILETS
FIRST FLOOR

PRIVATE ROOM OT
LABOUR ROOM

FEMALE WARD
WATER

STAFF NURSE DUTY ROOM

STAFF NURSE DUTY ROOM

MALE WARD WATER

 TOILETS
TOILETS

SECOND FLOOR
Page | 16

TOILETS OPERATTION THEATRE

COMPLEX

MALARIA WING

STAFF NURSE DUTY ROOM

WARD WATER FACILITY

BIRTH AND DEATH

REGISTRATION

PRIVATE ROOM

TOILETS STAFF NURSE DUTY ROOM

ORGANISATION CHART OF COMMUNKITY HEALTH CENTRE

LAMBI
BLOCK PUBLIC HEALTH UNIT

Medical superintendent Public health specialist Public health nurse

SPECIALITY SERVICES
 Physician General surgeon Obstetrician Pediatrician Anestheist

GENERAL DUTY OFFICERS

Page | 17

Dental surgeon General duty medical officer medical officer -AYUSH

NURSING & PARAMEDICAL STAFF

Staff nurse Pharmacist Pharmacist-AYUSH Lab. Technician

Radiographer Dietician ophthalmic assistant

Dental assistant cold chain OT technician counsellor

ADMINISTRATIVE STAFF

GROUP D STAFF

JOB DESCRIPTION OF STAFF WORKING AT COMMUNITY

HEALTH CENTRE
Job title Description

1. 1Medical officer  To achieve the aims and objectives of the Institute of Health.
 To provide health services viz. preventive, promotive,
curative and rehabilitation i.e. primary secondary and tertiary
care.
 To ensure that the law of the land is implemented in letter
and spirit especially the mental health act disability and equal
opportunities act, civil and communal laws, Punjab Service
and Financial Rules, Human Rights etc.
 Shall be overall responsible for the smooth running of the
hospital and perform all the duties assigned by the
Government for the said purpose.
 To plan and provide policy guidelines for the mental health
 activities of the State of Punjab.
 Liaison activities with neighbouring states and the Central
Government.
 Teaching, Research and Human Resource Development.
 To see that human rights of the mentally ill are not violated
Page | 18 at any cost. To make the junior staff aware of the rights of
the mentally ill.
2. 2Doctors  Shall be responsible for helping the Director in smooth
running of the hospital in the clinical, administrative, medico
legal, laision, research and teaching activities and any other
duty assigned by the Director.
 To maintain and ensure discipline in the hospital.
 To take the responsibilities of
stores and supplies.
 To report and prevent any incidence of ill treatment,
accident, violence and take to emergency measures.
 To ensure that the rights of the ill are not violated at any cost.
 To supervise and guide the junior staff and ensure that they
are carrying out all the responsibilities in toto and to take
immediate steps at their own level to rectify any minor defect
brought to their notice and report to the higher authorities
any suggestion for improvement.
 To take teaching responsibilities.
 To maintain proper clinical record and help in preparing
hospital statistics
3. 4Social Workers  Help in rehabilitation and discharge of the patient.
 Research and teaching.
 Community outreach and follow up other activities aimed
towards integrating the discharged patients within family &
community.
 Public Awareness by IEC activities.
 Liaison work.
 Any other responsibility assigned by the hospital authorities.
 Preparation of the hospital statistics.

4. 5Pharmacists  Supply of Drugs from Drug store and incharge of

medical equipment.
 Local purchase of material and their repair.
 To dispense medicines, injections etc. to the patients.
 To maintain proper stock, expense register and to prepare
hospital statistics.
 To raise annual demands, to ensure uninterrupted supply
of medicines and maintenance of medical equipment and
condemnation of unserviceable goods.
 5. 6Biochemist  All biochemical parameters in blood are tested plus all other
laboratory tests, maintaining the record, as well stock.

6. 7Computer Operator  All computer typing and preparation of all office statements
Page | 19  Checking and composing mails
 Supervision of computers
 Maintenance of computers
 Preparation of all hospital record statements, record keeping
etc.
7. 8Office  As per the Punjab Civil & Financial Service Rules
Superintendent  Any other responsibility assigned by the Director, IMH,
Amritsar
8. 9Statistical Assistant  As per the Punjab Civil & Financial Service Rules
 Maintenance of the old and new hospital, records,
preparation of the hospital statistics for state and central
government.
 Any other responsibility assigned by the Director, IMH,
Amritsar.

9. 1Senior Assistants  As per the Punjab Civil & Financial Service Rules
0  Proper maintenance of accounts and store branches and
record keeping
 Any other responsibility assigned by the Director, IMH,
Amritsar.

10. 1Clerks  As per the Punjab Civil & Financial Service Rules
1  Any other responsibility assigned by the Director, IMH,
Amritsar, in consultation with the Office Superintendent and
the Senior Assistant.
11. 1Matron  Participation in organisational activities of the institute under
2 the concerned authority of the institute.
 To allocate the Nursing Staff in the Clinical Area for
24 hours.
 To allocate duties and responsibilities of warders,
Class IV employees.
 Preparation of Duty Roster for all under employees.
 Maintenance of Records/Reports of under staff which
includes absentees, leave record, A.C.R. etc and other
documentation records.
 Guidance and Counseling.
 Daily Round of the clinical area, guidance supervision
and of the clinical staff and area.
 Imparting of service problem related with patient or
employees and clinical areas.
 Supervision of warder records related with the patients,
 period record for female patients, record, parole
register record and Senior patient record.
 Supervision of the activities of the Nursing Staff,
Rehabilitation Staff, warder staff and security staff.
 Participation in and among event and preparation of
Page | 20 special rounds.
 Human rights of the mentally ill are not violated at any
cost. To make the junior staff aware of the rights of
the ill.
12. 1Nursing Sister  To supervise the nursing staff and students.
4

13. 1Staff Nurses  To provide comprehensive care to the psychiatric patient

5  Taking and Handing over charge of
patients.
 Care of Personal Hygiene of
patients
 Emotional support to be provided
 Observation of Behaviour of mentally sick patients
 Provide medication/injection/other therapies in time
according to the prescription by the incharge doctor.
 Making local purchase and indent of the Drug Store.
14. 1Laboratory Assistant  To collect samples and in various list of blood, stool,
6 maintaining the record

15. 1Driver  To do duty with the Director in Staff Nurse.

7  To take patients for checkups in ambulance.
 To do any duty assigned by the Director IMH, Amritsar
16. 2Safai Sewaks - Mopping, cleaning, swapping floors
1 and toilets.
- To clean soiled clothes before

sending for washing.

- To clean the incontinent patients.
- To clean vomitous, urine etc.
immediately.
- To keep the toilets and floors
neat and clean at all the times
and to dry wet slippery floors.

- Assist warders and nursing staff

in maintaining personal hygiene of patients.
- To accompany the patients to other hospital for the same jobs as
above.

- To help very weak and debilitated patients in their daily activities.

 - Any other duty assigned by the hospital authorities.

- Proper disposal of solid waste.

17. 2Chowkidars - To check unauthorized entry at the gates at the hospital.

4
Page | 21

STAFFING PATTERN AT CHC LAMBI WITH JOB DESCRIPTION

PERSONNEL ESSENTIAL DESIRABLE AVATLABLE QUALIFICA REMARKS

TION
Block public health unit
Block Medical 1 1 1 Senior most Will be responsible
Officer/Medical specialist/ for
Superintendent GDMO coordination of
preferably NHPs,
with management of
experience in ASHAs
Public Training and other
Health/Traine responsibilities
d under
in NRHM apart from
Professional overall
Development administration/
Course Management of
(PDC) CHC etc. He will
be responsible for
quality & protocols
of
service delivery
being
delivered in CHC.
Public Health 1 1 - MD To provide
Specialist (PSM)/MD community
(CHA)/ medicine services
MD
Community
Medicine or
Post
Graduation
Degree
with
 MBA/DPH/M
PH
Public Health 1 2 - Graduate or To promote ,
Nurse Diploma in prevent and restore
(PHN) Nursing and health
Page | 22
will be trained
for 6 months
in Public
Health.
Degree /
Diploma in
Public health
nursing
Speciality Services
General 1 1 1 MS/DNB, Essential for
Surgeon (General utilization
Surgery) of the
Anaesthetist 1 1 - MD specialities. They
(Anesthesia)/ may
DNB/ be on contractual
DA/LSAS appointment or
trained MO hiring
Physician 1 2 1 MD/DNB, of services from
(General private sectors on
Medicine) per
Paediatrician 1 1 - DCH/MD case basis
(Paediatrics)/
DNB
Obstetrician & 1 2 1 DGO
Gynaecologist /MD/DNB
General duty officers
Dental Surgeon 1 1 1 BDS Dealing with dental
cases
General Duty 2 1 - MBBS Dealing with
Medical Officer medical
Medical officer 1 1 - Graduate in Providing AYUSH
– AYUSH AYUSH
Nurses and paramedical
15 14 GNM , B.Sc. , Nursing care
post basic B.Sc.
Staff Nurse 10 course
1 1 D. Pharmacy , Drugs handling
Pharmacist 1 B. paharmacy
 Pharmacist – 1 1 Degree in Drugs handling
AYUSH 1 AYUSH related to AYUSH
Radiographer 1 1 1 Degree in X-rays
radiography
Dietician 1 1 - Bachelors Diet maintenance of
Page | 23
degree in patients
nutrition
Ophthalmic 1 1 - Bachelors Assist in eye cases
Assistant degree in
ophthalmology
Dental Assistant 1 1 - Bachelors Assist in dental
degree in dental cases
Cold Chain & 1 1 - ANM Handling of live
Vaccine & diploma vaccines
logistic
assistant
1 1 1 Degree in OT Handling procedures
OT Technician in OT
Multi 1 1 - Degree in Social work
Rehabilitation/ sociology
Community
Based
Rehabilitation
worker
Counsellor 1 1 1 Degree in Counselling services
counselling
Administrative staff
Registration 1 1 1 +2 Registration
Clerk
Statistical 1 1 1 +2 Data entry
Assistant/ Data
Entry
Operator
Account 1 1 1 +2 Data entry
Assistant
Administrative 1 1 1 +2 Administration
Assistant
Class 4 staff
Dresser 1 1 - 10th
(certified
by Red
Cross/Johns
Ambulance)
 Ward 5 5 5 10th
Boys/Nursing
Orderly
Driver 1 3 2 10th
GUIDELINES FOR CHC LAMBI:
Page | 24
Community Health Centre (CHC) – First Referral Unit (FRU) Assured Services:

NRHM envisages a 30-bedded fully functional block level rural hospital. The greatest
challenge of bringing these CHCs to FRU / IPHS is the nonavailability of the specialists
especially the critical ones like obstetric/gynecologist, anesthetist and pediatrician. The
following steps may be taken up:

♦ Conduct an institution specific facility survey and identify the gaps.

♦ The bringing up the CHC to the level of the IPHS may be carried out in stages.

FIRST STAGE:- It must be ensured that all the CHCs provides 24x7 services with
appropriate referral transport service. The basic requirement for making it 24x7
service delivery, there should be four General Duty Medical Officers and seven Staff
Nurses, one ANM and one LHV along with other support services and physical
facilities. Each CHC must be certified by the State Government / District Authority
that this is functioning as a 24x7 service delivery.
SECOND STAGE:- All the CHCs, declared as 24x7 may be upgraded to First
Referral Units (FRUs). The Minimum requirement of FRUs including manpower, i.e.
gynecologist, anesthetist, pediatrician, and round the clock services of nurses and
general duty officers should be ensured. Blood storage facility and other supportive
services such as laboratory, X-ray, OT, labour room, laundry, diet, waste management
system, referral transport etc. must be ensured. Each CHC should be clearly
demarcated as FRU. CHCs, as FRU, will provide the 24 Hours delivery services
including normal and assisted deliveries, emergency obstetric care including surgical
intervention like cesarean section and other medical intervention, newborn care,
emergency care of sick children, full range of family planning services including
laparoscopic services, safe abortion services, treatment of STI/RTI, availability of
blood storage unit or effective linkage facilities with blood banks, and referral
transport services.
THIRD STAGE (IPHS):- Once the CHCs are qualified for FRU, next step would be
to post adequate number of other specialists and support manpower as per the IPHS.
 Once these existing gaps in relation to manpower, equipments, drugs, supplies and
other support services, are filled up, the CHCs can be declared to have achieved
IPHS. The CHCs declared as IPHS, apart from above mentioned services by FRU,
also must provide the following services:
Page | 25
♦ Care of routine and emergency cases in surgery
♦ Care of routine and emergency cases in medicine
♦ Services of a Public Health Manager
♦ Delivery of all National Health Programmes including communicable and non-
communicable diseases and RCH services.

MANPOWER:
 ♦ Appointment of specialists may be made on contractual basis. All out efforts should be
made, such as contractual appointment or walk-in interviews, making the specialist cadre in
the State and even appointment of retired specialists on contractual basis, public private
partnership, and other incentives provided by the State government. Short term training
Page | 26
course on anesthesiology and emergency obstetric care to the existing serving general duty
doctors may also be undertaken, to see that all the CHCs have requisite manpower depending
on the bed occupancy level.

♦ Appointment of Public Health Programme Manager on contractual basis.

♦ Appointment of Eye Surgeon (one for five CHCs) on contractual basis.
♦ Appointment of nine Nurses Midwives / Staff Nurses on contractual basis.
♦ All the existing Community Health Centres buildings as far as possible should be made
environment friendly, disabled friendly, with a good source of water supply, electricity / solar
power / other alternative energy sources and telephone. Rain water harvesting should also be
promoted in the CHC buildings. This can be ensured with the help of Panchayat and related
sectors such as water supply sanitation, horticulture etc. All the proposed new buildings
should have these components in their construction plan.

♦ Dislocation of the existing centres for the sake of achieving the Standards may not be
required, unless compulsory due to unavoidable circumstances. In that case, they could be
resettled to an accessible place where the original client group could easily get the services.
As far as manpower is concerned, optimum strength should be taken into consideration.

OTHERS

♦ Utilization of untied fund for strengthening the functioning of CHCs

♦ Utilization of Annual Maintenance Grant for strengthening the infrastructure and basic
necessities
♦ Utilization of fund for up-gradation of CHCs to IPHS

Implementation of achieving the Standards should keep into account the linkage of the
referral system right from Sub-centre to Community Health Centres and to higher up
institutions from CHCs.

SERVICE DELIVERY IN CHC LAMBI

General, Medicine, Surgery, Obstetrics & Gynaecology, Paediatrics, Dental and AYUSH
services.
  Eye Specialist services.
 Emergency Services
 Laboratory Services
 National Health Programmes
a.CARE OF ROUTINE AND EMERGENCY CASES IN SURGERY
Page | 27 o This includes dressings, incision and drainage, and surgery for Hernia, Hydrocele,
Appendicitis, Haemorrhoids, Fistula, and stitching of injuries.
o Handling of emergencies like Intestinal Obstruction, Haemorrhage, etc.
o Other management including nasal packing, tracheostomy, foreign body removal etc.
o Fracture reduction and putting splints/plaster cast. Conducting daily OPD.

b. CARE OF ROUTINE AND EMERGENCY CASES IN MEDICINE :

o Specific mention is being made of handling of all emergencies like Dengue
Haemorrhagic Fever, Cerebral Malaria and others like Dog & snake bite cases,
Poisonings, Congestive Heart Failure, Left Ventricular Failure, Pneumonias,
meningoencephalitis, acute respiratory conditions, status epilepticus, Burns, Shock,
acute dehydration etc.
o In case of National Health Programmes, appropriate guidelines are already available,
which should be followed. Conducting daily OPD.
c. MATERNAL HEALTH
Minimum 4 ANC check ups including Registration & associated services : As
some antenatal cases may directly register with CHC the suggested schedule of
antenatal visits is reproduced below.

1st visit: Within 12 weeks—preferably as soon as pregnancy is suspected—for

registration of pregnancy and first antenatal check-up.

2nd visit: Between 14 and 26 weeks

3rd visit: Between 28 and 34 weeks

4th visit: Between 36 weeks and term

 24-hour delivery services including normal and assisted deliveries.

  Managing labour using Partograph.
 All referred cases of Complications in pregnancy, labour and post-natal period must
be adequately treated.
 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 &
Page | 28
42nd day post-natal home visits.
 Minimum 48 hours of stay after delivery, 3-7 days stay post delivery for managing
Complications.
 Proficiency in identification and Management of all complications including PPH,
Eclampsia, Sepsis etc. during PNC.
 Essential and Emergency Obstetric Care including surgical interventions like
Caesarean Sections and other medical interventions.
 Provisions of Janani Suraksha Yojana (JSY) and Janani Shishu Suraksha Karyakram
(JSSK) as per guidelines.
d. NEWBORN CARE AND CHILD HEALTH

i. Early initiation of breast feeding with in one hour of birth and promotion of
exclusive breast-feeding for 6 months.
 Newborn Stabilization Unit
 Counseling on Infant and young child feeding as per IYCF guidelines.
 Routine and emergency care of sick children including Facility based IMNCI strategy.
 Full Immunization of infants and children against Vaccine Preventable Diseases and
 Vitamin-A prophylaxis as per guidelines of Govt. of India. Tracking of vaccination
drop outs and left outs.
 Prevention and management of routine childhood diseases, infections and anemia etc.
 Management of Malnutrition cases.
 Provisions of Janani Shishu Suraksha Karyakram (JSSK) as per guidelines.
 Essential Newborn Care and Resuscitation by providing Newborn Corner in the
Labour Room and Operation Theatre (where caessaria
e. FAMILY PLANNING
 Full range of family planning services including IEC, counseling, provision of
Contraceptives, Non Scalpel Vasectomy (NSV), Laparoscopic Sterilization Services
and their follow up.
 Safe Abortion Services as per MTP act and Abortion care guidelines of MOHFW.
 MTP Facility approved for 2nd trimester of pregnancy.
f. OTHER NATIONAL HEALTH PROGRAMMES (NHP): (Essential Except as
Indicated)

All NHPs should be delivered through the CHCs. Integration with the existing
programmes is vital to provide comprehensive services. The requirements for the
important NHPs are being annexed as separate guidelines and following are the assured
services under each NHP.

Communicable Diseases Programmes

  RNTCP: CHC should provide diagnostic services through the microscopy centres
which are already established in the CHCs and treatment services as per the
Technical and Operational Guidelines for Tuberculosis Control .
 HIV/AIDS Control Programme: The services to be provided at the CHC level are .
o Integrated Counselling and Testing Centre.
Page | 29 o Blood Storage Centre .
o Sexually Transmitted Infection clinic.
Desirable

Link Anti Retroviral Therapy Centre.

 National Vector Borne Disease Control Programme: The CHCs are to provide
diagnostic/linkages to diagnosis and treatment facilities for routine and complicated
cases of Malaria, Filaria, Dengue, Japanese Encephalitis and Kala-azar in the
respective endemic zones .

 National Leprosy Eradication Programme (NLEP): The minimum services that

are to be available at the CHCs are for diagnosis and treatment of cases and
complications including reactions of leprosy along with conselling of patients on
prevention of deformity and cases of uncomplicated ulcers
 National Programme for Control of Blindness: The eye care services that should
be made available at the CHC are as given below.
 Vision Testing with Vision drum/Vision Charts.
 Refraction
 The early detection of visual impairment and their referral.
 Awareness generation through appropriate IEC strategies and involving
community for primary prevention and early detection of impaired vision and
other eye conditions.
 National Programme for Prevention and Control of Deafness (NPPCD):

CHC will provide following services:

 The early detection of cases of hearing impairment and deafness and referral.
 Provision of Basic Diagnosis and treatment services for common ear diseases.
 Awareness generation through appropriate IEC strategies and greater participation/
role of community in primary prevention and early detection of hearing impairment/
deafness.
 National Mental Health Programme (NMHP)

 Early identification, Diagnosis and treatment of common mental disorders (anxiety,

depression, psychosis, schizophrenia, Manic Depressive Psychosis).
 IEC activities for prevention, removal of stigma and early detection of mental
disorders.
 Follow up care of detected cases who are on treatment.
  National Programme for Prevention and Control of Cancer, Diabetes,
Cardiovascular Diseases and Stroke (NPCDCS)
a. Cancer Control

Facilities for early detection and referral of suspected cancer cases.

Page | 30 Screening for Cervical, Breast & Oral Cancers.
Education about Breast Self Examination and Oral Self Examination.
Investigations to confirm diagnosis of cancer in patients with early warning signals
through Public Private Partnership mode.
b. Diabetes, CVD and Strokes

Promotion & Prevention

Health Promotion: Focus will be on healthy population.

Modify individual, group and community behaviour through intervention like,
o Promotion of Healthy Dietary Habits.
o Promotion of physical activity.
o Avoidance of tobacco and alcohol.
o Stress Management.
Treatment & Timely Referral (Complicated cases) of Diabetes Mellitus,
Hypertension, IHD, CHF etc.
Assured investigations: Urine Albumin and Sugar, Blood Sugar, Blood Lipid
Profile, KFT (Blood urea, creatinine) ECG.
c. National Iodine Deficiency Disorders Control Programme (NIDDCP)

IEC activities in the form of posters, pamphlets, Interpersonal communication

by the people and monitoring of iodised salt through salt testing kits.

 National Programme for Prevention and Control of Fluorosis (NPPCF)

Essential in Fluorosis affected Villages

o Clinical examination and preliminary diagnostic parameters assessment for cases of

Fluorosis if facilities are available.
o Monitoring of village/community level Fluorosis surveillance and IEC activities.
o Referral Services. IEC activities in the form of posters, pamphlets, Interpersonal
communication to prevent Fluorosis.
 National Tobacco Control Programme (NTCP)

 Health education and IEC activities regarding harmful effects of tobacco use and
second hand smoke.
 Promoting quitting of tobacco in the community and offering brief advice to all
smokers and tobacco users.
 Making the premises of CHC tobacco free and display of mandatory signages.
 National Programme for Health Care of Elderly

 Medical rehabilitation services.

  Compilation of elderly data from PHC & forwarding the same to district nodal
officers.
 Visits to the Homes of disabled/bed ridden persons by rehabilitation worker on
receiving information from PHC/Sub-centre.
 Geriatric Clinic: twice a week.
Page | 31  Physical Medicine and Rehabilitation (PMR)

 Primary prevention of Disabilities.

 Screening, early identification and detection
 Counselling.
 Issue of Disability Certificate for obvious Disabilities by CHC doctors.
 Community based Rehabilitation Services.
 Oral Health

 Dental care and Dental Health education services as well as root canal treatment and
filling/extraction of routine and emergency cases.
 Oral Health education in collaboration with other activities e.g. Nutritional
education, school health and adolescent health.
g. OTHER SERVICES
a. 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

 Screening, health care and referral:

o Screening of general health, assessment of Anaemia/Nutritional status, visual

acuity, hearng problems, dental check up, common skin conditions, Heart
defects, physical disabilities, learning disorders, behavior problems, etc.
o Basic medicines to take care of common ailments, prevalent among young
school going children.
o Referral Cards for priority services at District / Sub-District hospitals.
 Immunization:
 As per national schedule
 Fixed day activity
 Coupled with education about the issue
 Micronutrient (Vitamin A & IFA) management:
o Weekly supervised distribution of Iron-Folate tablets coupled with education
about the issue
o Administration of Vitamin-A in needy cases.
 De-worming
o Biannually supervised schedule
 o Prior IEC
o Siblings of students also to be covered
 Capacity building
 Monitoring & Evaluation
 Mid Day Meal
Page | 32  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.
b. Adolescent Health Care

To be provided preferably through adolescent friendly clinic for 2 hours once a week on a
fixed 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

Outreach services in schools (essential) and community Camps (desirable):

Periodic Health check ups and health education activities, awareness generation and
Co-curricular activities

c. Blood Storage Facility

d. Diagnostic Services
  In addition to the lab facilities and X-ray, ECG should be made available in the CHC
with appropriate training to a nursing staff/Lab. Technician.
 All necessary reagents, glass ware and facilities for collecting and transport of
samples should be made available.
e. Referral (transport) Services
Page | 33 f. Maternal Death Review (MDR).

BUDGETING AT COMMUNITY HEALTH CENTRE , LAMBI

INTRODUCTION

Every organization has predetermined set of goal and objective which are attainable
only with help of power planning and execution of plan economically. The plan are in the
form of statement are called budget. Every organization prepares the budget for its
functioning.

Budget expresses the plan of hospital in health organization to provide optimum care
at a reasonable cost in financial terms.

DEFINITION

A budget is a tool for planning, quantifying the plan and controlling cost.

Finkler, 1984

A budget is a plan that uses numerical data to predict the activities of an organization
over a period of time and it provide a mechanism for planning each unit’s needs and
contributes.

Carruth, Carruth and Notto, 2000

PURPOSES OF BUDGETING : The purposes of budgeting are:

1. Budget supplies the mechanism for translating fiscal 1-year objectives into projected
monthly spending pattern.
2. Budget enhances fiscal planning and decision making.
3. Budget clearly recognizes controllable and uncontrollable cost areas.
4. Budget allows feedback of utilization of budget.
5. Budget helps to identify problem areas and facilities for effective solution.

CHARACTERISTICS

 It is a plan or program, framed on the basis of past experience.

 Budget is a scheme for action
 Is should estimate the revenues and expenditure as accurately as possible.
 There is a generally annual plan.
 It is a comprehensive Plan of action.
 IMPORTANCE OF BUDGET

1. Budget is needed for planning for future course of action and to have a control over all
activities in the organization.
2. Budget facilitates coordinating of various departmental and selection for realizing
Page | 34 organizational objectives
3. Budget serves as a guide for action in the organization.
4. The budget tells you how much money you need to carry out your activities.
5. The budget to monitor income and expenditure and identify any problem.

PRINCIPLE OF BUDGET

 Budget should provide sound financial management by focusing on requirement of the

organization.
 Budget should focus on objectives and policies of the organization. It must flow from
objectives and give realistic expression to the way of realistic such objective.
 Budget requires that program activities planned in advance.
 Budgetary process requires consistent delegation for which fixed duties and responsibilities
are required to be allocated to managers at different level for framing and executing budget.
 Budget should include co-coordinating efforts of various departments establishing a frame of
reference for managerial decision and providing certain criteria for evaluating managerial
performance.
 Budget period must be appropriate to the nature of business or service and to type of budget.
 Budget is prepared under the direction on the supervision of the administration or financial
officer.
 Budget is to be prepared and interpreted consistently throughout the organization in the
communication in the planning process.
 While developing budget , provision must be made for its flexibility

TYPES OF BUDGET

1. Capital expenditure budget – this type of budget includes the purchase the land,
buildings, a major equipment’s of considerable expense and lifelong.
2. Operating budget - It includes the cost of supplies, minor equipment repairs, and
overhead expenses.
3. Fixed budget - This refers to those components of budgets that will not vary regardless of
change in patient census or number of procedures.
4. Flexible budget - It refers to those components of budgets that will determine how the
budget will fluctuate, based on those changes in the number of procedure or unit of
activity.
5. Open ended budget – It is financial plan in which each operating managers presents a
single cost estimate for which she consider the optimal activity level for each program,
without indicating how the plan should be scaled down if less funding is available.
6. Historical budget - In historical budget, the previous year expenses are used as basis for
expenses for the next year.
 7. Statistical budget or forecast budget - this type of budget is developed by establishing a
level of anticipated activity based on historical or other data such as loss or gain of specific
program.
8. Trended budget - Trended budget is one that is developed based on the previous year
expenditure pattern.
Page | 35
9. Zero based budget - it is one of the budget that do not utilize any historical data to
determine activity level or expenses anticipated .all the expenses are justified based on
expectation or desires for the upcoming year.

10. Revenue and expense budget - it is expressed in financial terms and take the nature of the
Performa income statement for the future. It shows items of profit and loss under classified
headings.

11. Cash budget - This is prepared by way projecting possible cash receipts and payments
over budget periods.

12. Program budget - It is one where cost are computed for a total program.

13. Performance budget - It is based on function such as direct nursing care, supervision, in-
service.

STEPS IN BUDGETING

While designing and implementing a planning program, the nurse administrator/

manager should follow steps –

STEPS IN PREPARATION OF NURSING BUDGET

 Revise the
Review the
Review the Prepare a existing
objectives of
goals of the budget program with
the existing
hospital proposal the revised
programmes
proposal
Page | 36
Prepare a
Adopt the
budget request Compare the
alternative Compute the
which details a proposal to
approach for expense for
fiscal plan for identify the
realizing the each program
the preferred effective
Review the one
proposed plan
program budget
appropriation Determine the
Prepare a new percentage of
and actual
budget is to salaries in
Present the expenditure for
cover in terms various
need of the current department of
of nursing
required staffs year nursing based on
service
conjunction the time
required
with current allocated
hospital
statistics Prepare the
Submit the Estimate the
summary of
report to the requirement
new needs to
head of the for the coming
support the
department year
request

BUDGET PLAN OF OBSTETRIC AND GYANAECOLOGY WARD

(BED SIZE-30)

UNIT TOTAL
REQUIRED
S.N. DESCRIPTION OF ITEM COST COST
QUANTITY
(Rs.) (Rs.)
EQUIPMENT
1. Stethoscope 2 400 800
2. B.P. Apparatus 2 1800 3600
3. weighing machine 1 1500 1500
4. Nebulizer machine 1 2500 2500
5. Oxygen cylinder (5 litre) 1 7300 7300
6. Suction apparatus(mobile) 1 15000 15000
7. Pulse oximetry 1 5000 5000
8. Glucometer 1 2220 2220
9. Ambu bag set 1 1000 1000
10. X ray view box 1 13000 13000
11. Needle cutter 1 3500 3500
12. Hammer 1 220 220
13. Tongue depressor 2 50 100
14. Cheatle forceps 1 250 250
15. Injection tray 2 150 300
 16. Dressing tray 2 170 340
17. Sterile Drum 1 600 600
18. Tuning fork 1 170 170
19. Digital Thermometer 1 250 250
20. Scissors 1 120 120
Page | 37 21. Air way 5 30 150
22. Mackintosh 3 1000 3000
23. Tourniquet 2 50 100
24. Hot water bag 1 500 500
25. Kidney tray 3 70 210
FURNITURE
26. Cot 30 13000 390000
27. Stool 30 1000 30000
28. Side locker 30 5200 156000
29. IV stand 30 2900 87000
30. Crash cart 1 15000 15000
31. Medicine trolley 1 14400 14400
32. Dressing trolley 1 14400 14400
33. Chair 3 500 1500
34. Table 1 3500 3500
35. Wheel chair 1 6000 6000
36. Bed side screen 1 5000 5000
37. Foot step 1 3000 3000
38. Cylinder trolley 1 3500 3500
MISCELLENOUS
1 Refrigerator 1 13000 13000
2 Fan 15 1200 18000
3 Tube light 35 220 7700
4 Telephone 1 3000 3000
5 Punching machine 2 70 140
6 Notice board 1 550 550
7 Waste disposal containers 4 250 1000
Stationary items (Register, Paper,
8 10000
Forms, Files etc.)
SALARY
1 Sister In charge 1 30,000 30000
2 Staff Nurse 10 15,000 150000
3 Ward Aid 3 6000 18000
Total expenditure 1042420
Income and Expenditure Statement

Income and expenditure statement reflects the results of the hospitals operation for a
stated period. The income and expenditure of various departments are worked out department
wise. This is essential for the purpose of evaluating financial performance of each
department, and in determination of cost of providing each service.
 Income: It accrues from the following sources.

1. Routine medical care service

 Room, food, medical care, nursing care
 Outpatients consulting, injections, dressings, minor procedures
Page | 38  Emergency and casualty services

2. Special departmental services

 Operation theaters
 Delivery room
 ICU
 Pathology
 Radiology
 Physiotherapy
 Pharmacy
3. Other income
 Fees for training programs
 Canteen, parking lot
 Ambulance
4. Non-operating income
 Donations
 Grants
 Property rentals
 Bank interest and investment returns

Expenditure: It is incurred from the following sources.

1. Operating expenditure
 Salaries, including contribution to employee provident fund and gratuity
 Supplies and materials
 Utilities (Electricity, water, telephones etc.)
 Maintenance
 Administrative expenses

2. Other expenses
 On training programs

3. Non-operating expenses
 Depreciation
 Interest on borrowed capital
 Upkeep of properties

1) State Illness Fund:

 The aims & objectives of the Society shall be to manage & operate State Illness Fund:-
(I) To provide financial assistance for general and specialized treatment to the poor people
/economically weaker section of the society in the Government multi/super specialty
hospitals/ institutes for;
(i) Life threatening diseases;
Page | 39
(ii) Treatment of Injuries caused by natural or manmade disasters, industrial / farm / road/
rail/accidents, bomb blasts, natural Calamities etc;
(II) To mobilize resources through Govt. of India / State Govt./State Health
Society/Voluntary and Charitable organizations/ individual & foreign institutions; and
(III) To receive financial assistance from Rashtriya Arogya Nidhi (RAN).

SCOPE OF FUNCTIONS : To achieve the above objectives, the Society shall direct its
resources towards performance of the following key tasks:
i) Identifying beneficiaries, categories of medical treatment to be provided.
ii) Acquiring equipment, furniture, vehicles (through purchase donation, rental or any other
means including loans from banks) for the management of the society.
iii) Entering into any partnership arrangement with private sector / Government
institutions/medical colleges (including individual) for fulfilling the objectives of the society.
iv) Encouraging community participation in order to increase resource base of the society by
launching special campaigns.
v) To formulate and implement any other scheme for achievement of objective of the society.
vi) To make guidelines/rules for fulfilling objectives of the society.
vii) To decide and regulate all matters concerning the aims and objectives of the society.

Budget Provision: Rs. 200.00 lakh

Budget allocated to each of its agency, indicating the particulars of all plans, proposed expenditure
and reports on disbursement made)

Budget Allocation

The Health Institutions under the Punjab Health Systems Corporation provide free medical
facilities to the following categories:

 Holders of Yellow Card and their dependent family members.

 Punjab Govt. Employees and their dependent family members.
 Punjab Govt. Pensioners and their dependent family members.
 Past & present member of legislative assembly legislative council and parliament and
their dependent family members.
 Hon'ble Judges and staff member of Punjab & Haryana High Court and their
dependent family members.
 Staff members of Punjab Vidhan Sabha and their dependent family members.
 Freedom Fighters and their dependent family members.
 Under trial prisoner and convicts.
 Ex-Servicemen.
 Also treatment is free for all emergencies arising out of roadside accident, man made or
natural disaster like; floods earthquake, building collapse drowning poisoning burns
shootouts and unknown and unaccompanied cases. Free treatment is being provided for
services under the ongoing national programs.

Page | 40
PROBLEM SOLVING PROCESS

COMMUNITY HEALTH CENTRE , LAMBI

PROBLEM

A matter or situation regarded as unwelcome or harmful and needing to be dealt with and
overcome. something that causes difficulty or that is hard to deal with or a problem is also a
question to be answered or solved, especially by reasoning or calculating.

A perceived gap between the existing state and a desired state, or a deviation from a norm,
standard, or status quo. Although many problems turn out to have several solutions (the
means to close the gap or correct the deviation), difficulties arise where such means are either
not obvious or are not immediately available.

A problem is a situation preventing something from being achieved. The word comes from a
Greek word meaning an "obstacle" (something that is in your way). Someone who has a
problem must find a way of solving it. The means of solving a problem is called a "solution".

PROBLEM SOLVING:-

Problem solving is the act of defining a problem, determining the cause of the problem,
identifying, prioritizing and selecting alternatives for a solution, and implementing a solution.

The problems India facing today in healthcare are:

1) Lack of infrastructure : Lack of continuous water supply in many PHC’S, some government
building is being used as a primary health center at some places etc.

2)Inefficient workforce : we need to introduce an efficient check on working of medical officers

and the auxillary staff.

3)Awareness of the people : A lot of primary health problems can be solved if we provide
effective training and the knowledge to the local population.

Irrespective of the high tech nature of modern healthcare delivery, it is the personnel,
who wield the technology to provide services, who matter the most. The impact of
deficiency or absence of one category of health personnel is not restricted to “a
particular service” delivery but impacts the integrated nature of functioning of a
modern hospital.
Page | 41

STEPS OF PROBLEM SOLVING :

Here are seven-steps for an effective problem-solving process.

1. Identify the issues.

 Be clear about what the problem is.

 Remember that different people might have different views of what the issues are.
 Separate the listing of issues from the identification of interests (that's the next step!).

2. Understand everyone's interests.

 This is a critical step that is usually missing.

 Interests are the needs that you want satisfied by any given solution. We often ignore
our true interests as we become attached to one particular solution.
 The best solution is the one that satisfies everyone's interests.
 This is the time for active listening. Put down your differences for awhile and listen to
each other with the intention to understand.
 Separate the naming of interests from the listing of solutions.
 3. List the possible solutions (options)

 This is the time to do some brainstorming. There may be lots of room for creativity.
 Separate the listing of options from the evaluation of the options.

Page | 42 4. Evaluate the options.

 What are the pluses and minuses? Honestly!

 Separate the evaluation of options from the selection of options.

5. Select an option or options.

 What's the best option, in the balance?

 Is there a way to "bundle" a number of options together for a more satisfactory
solution?

6. Document the agreement(s).

 Don't rely on memory.

 Writing it down will help you think through all the details and implications.

7. Agree on contingencies, monitoring, and evaluation.

 Conditions may change. Make contingency agreements about foreseeable future

circumstances (If-then!).
 How will you monitor compliance and follow-through?
 Create opportunities to evaluate the agreements and their implementation. ("Let's try
it this way for three months and then look at it.")

Effective problem solving does take some time and attention more of the latter than the
former. But less time and attention than is required by a problem not well solved. What it
really takes is a willingness to slow down. A problem is like a curve in the road. Take it right
and you'll find yourself in good shape for the straightaway that follows. Take it too fast and
you may not be in as good shape.

I had my clinical posting at Community health centre , Lambi and I noticed several
problems there that are affecting the work performance of the health personnel and the
quality of health care provided to the clients in the hospital.

PROBLEM SOLVING TECHNIQUES

To understand the necessary skills in problem solving, you should first understand the types of
thinking often associated with strong decision making. Most problem solving techniques look for a
balance between the following binaries:

 Convergent vs. Divergent Thinking: Convergent thinking is bringing together disparate

information or ideas to determine a single best answer or solution. This thinking style values
 logic, speed, and accuracy, and leaves no chance for ambiguity. Divergent thinking is focused
on generating new ideas to identify and evaluate multiple possible solutions, often uniting
ideas in unexpected combinations. Divergent thinking is characterized by creativity,
complexity, curiosity, flexibility, originality, and risk-taking.
Page | 43  Pragmatics vs. Semantics: Pragmatics refer to the logic of the problem at hand, and
semantics is how you interpret the problem to solve it. Both are important to yield the best
possible solution.
 Mathematical vs. Personal Problem Solving: Mathematical problem solving involves logic
(usually leading to a single correct answer), and is useful for problems that involve numbers
or require an objective, clear-cut solution. However, many workplace problems also require
personal problem solving, which includes interpersonal, collaborative, and emotional intuition
and skills.
The following basic methods are fundamental problem solving concepts. Implement them to help
balance the above thinking models.

 Reproductive Thinking: Reproductive thinking uses past experience to solve a problem.

However, be careful not to rely too heavily on past solutions, and to evaluate current problems
individually, with their own factors and parameters.
 Idea Generation: The process of generating many possible courses of action to identify a
solution. This is most commonly a team exercise because putting everyone’s ideas on the
table will yield the greatest number of potential solutions.
INEFFICIENCIES IN HEALTHCARE DELIVERY AT
COMMUNITY HEALTH SYSTEM LAMBI

SOURCE OF COMMON REASONS FOR WAYS TO ADDRESS

INEFFICIENCY INEFFICIENCY
1. Medicines: under use of Inadequate controls on supply
generics and higher than agents, prescribers and
necessary prices for dispensers; lower perceived
medicines efficacy and safety of generic
medicines; historical prescribing
patterns and inefficient
procurement and distribution
systems; taxes and duties on
medicines; excessive mark-ups
INEFFICIENCY
Improve prescribing guidance
information, training and
practice. Require, permit or offer
incentives for generic
substitution. Develop active
purchasing based on assessment
of costs and benefits of
alternatives. Ensure transparency
in purchasing and tenders.
Remove taxes and duties. Control

2. Medicines: use of
substandard
Page | 44
3. Medicines:
inappropriate and
ineffective use
4. Healthcare products
and services: overuse or
supply of equipment,
investigations and
procedures
5. Health workers:
inappropriate or costly
services
6. Healthcare services:
inappropriate hospital
admissions
7. Healthcare services:
inappropriate hospital size
(inefficient use of
infrastructure)
8. Healthcare services:
Inadequate pharmaceutical
regulatory structures mechanisms
and weak procurement systems
Inappropriate prescriber
incentives and unethical
promotion practices; consumer
demand and expectations; limited
knowledge about therapeutic
effects; inadequate regulatory
frameworks
Supplier-induced demand; fee-for
service payment mechanisms; fear
of litigation
Conformity with predetermined
human resource policies and
procedures; resistance by medical
profession; fixed or inflexible
contracts; inadequate salaries;
recruitment based on favouritism
Lack of alternative care
arrangements; insufficient
incentives to discharge; limited
knowledge of best services
Inappropriate level of managerial
control; too many hospitals and
in-patient beds in some areas, not
enough in others, often reflecting
lack of planning for health se
Insufficient knowledge or
excessive mark-ups. Monito
Strengthen the manufacture of
medicines; carry out product
testing; enhance procurement
systems .
Separate prescribing and
dispensing promotional activities;
improve prescribing guidance,
information, training and practice
and disseminate public
information
Reform incentive and payment
structures (e.g., capitation or
diagnosis-related group); develop
and implement clinical guidelines
Undertake needs based
assessment and training revise
remuneration policies; introduce
flexible contracts and
performance-related pay;
implement task-shifting and other
Provide alternative care); alter
incentives to hospital providers;
raise awareness about admissions
procedures
Incorporate inputs and outputs
match managerial capacity to
size; reduce excess capacity to
raise occupancy rate to 80-90%
while controlling length of stay
Improve hygiene standards in
 medical errors and sub
optimal quality of care
9. Health system leakages: Unclear resource allocation
Page | 45
waste, corruption and
fraud
10. Health interventions:
inefficient mix and
inappropriate level of
strategies
application of clinical care
standards and protocols; lack of
guidelines, inadequate supervision
guidance; lack of transparency;
poor accountability and
governance mechanisms , low
salaries
Funding high-cost, low-effect
interventions when lowcost, high-
impact options are unfunded;
inappropriate balance between
levels of care and among
prevention, promotion and
treatment
hospitals; provide more
continuity of care; under take
more clinical audits;
Improve regulation and
governance , including strong
sanction mechanisms; assess
transparency and vulnerability to
corruption; under take public
spending tracking surveys
Conduct regular evaluations ,
incorporate into policy of
evidence on the costs and impact
of interventions, technologies,
medicines and policy options.

PROBLEM 1

Lack of proper sanitation and hygiene in the ward :- There were no proper or adequate
hygiene in the washrooms, Inadequate and poorly ventilated toilets and the wards of the
patients.

Alternative solutions

 Patient should complaint to staff about problem. Staff should listen the problem and
report it to higher authority for help.
 Performance incentive plans should be made that targets specific treatment parameters
would be a useful adjunct.
 For washroom water supply there should be more hours in both morning and evening.
 Washrooms and clients wards should be cleaned twice daily.

Select the best solution

 Patient should complaint to staff about problem. Staff should listen the problem and
report it to higher authority for help.
  Performance incentive plans should be made to check the performance of the workers
regularly

Implement the solution

Page | 46
 Performance incentive plans should be made that targets specific treatment parameters
would be a useful adjunct.
 Patient store water in bucket and no complaint of water problem in washroom now.

Evaluation

 Therapeutic condition of the ward is maintained to some extent..

 Availability of water in washroom solved.

PROBLEM 2

Lack of nursing personnel in the ward :- Problem is that there are less number of
personnel in the ward which causes imbalance of work in ward and affect quality of care
given to the patient. Little interaction of staff with patient as a result of this.

Alternative solutions

 Nursing personnel can discuss this problem of over burden with doctor in charge of
the center.
 As this is under government, so new vacancies can be created and recruitment can be
done.
 Duty hours of the staff should be increased until the problem get solved
 No. of admission to ward can be reduced. Patient should be treated on out-patient
basis. Only significant patient should be admitted to ward.

Select the best solution

 Nursing personnel can discuss this problem of over burden with doctor in charge of
the center.
 As this is under government, so new vacancies can be created and recruitment can be
done.

Implement the solution

  Doctor have reported the shortage of staff in ward to government through proper
channel.
 Problem is discussed with higher authorities of the hospital.

Page | 47 Evaluation

 Government had appointed new staff in centre recently. It helps to reduce the burden
on staff and now ward functioning is running smoothly.
 New appointed staff: 4
 Helper: 2

PROBLEM 3:- Expensive health services in the hospital :- one of major problem is that
clients & their attendants fees of de-addiction centre is very costly. As a result, they cannot
afford treatment in government centre.

Alternative solutions

 As the state government runs the centre, so fees can be decreased by government.
 Clients should also co-operate with the government, because the drug supplied to
patient are expensive.
 Discuss this issue with government agency.

Select the best solution

 As the state government runs the centre, so fees can be decreased by government.
 Discuss this issue with government agency.

Implement the solution

 Discussed this problem with governmental high authority and try to find out solution
for this problem.

Evaluation

Government had launched various schemes with no announced fee care to the admitted
patients. No fees will be charged from patient. Free treatment & accommodation services are
provided to the patients.

PERFORMANCE APPRAISAL
 Performance Appraisal is the systematic evaluation of the performance of employees and to
understand the abilities of a person for further growth and development. Performance
appraisal is generally done in systematic ways which are as follows:

 The supervisors measure the pay of employees and compare it with targets and plans.
Page | 48  The supervisor analyses the factors behind work performances of employees.
 The employers are in position to guide the employees for a better performance.

Objectives of Performance Appraisal

Performance Appraisal can be done with following objectives in mind:

To maintain records in order to determine compensation packages, wage structure,

salaries raises, etc.
To identify the strengths and weaknesses of employees to place right men on right
job.
To maintain and assess the potential present in a person for further growth and
development.
To provide a feedback to employees regarding their performance and related status.
To provide a feedback to employees regarding their performance and related status.
It serves as a basis for influencing working habits of the employees.
To review and retain the promotional and other training programmes.

Advantages of Performance Appraisal

It is said that performance appraisal is an investment for the company which can be justified
by following advantages:

 Promotion: Performance Appraisal helps the supervisors to chalk out the promotion
programmes for efficient employees. In this regards, inefficient workers can be
dismissed or demoted in case.
 Compensation: Performance Appraisal helps in chalking out compensation packages
for employees. Merit rating is possible through performance appraisal. Performance
Appraisal tries to give worth to a performance. Compensation packages which
includes bonus, high salary rates, extra benefits, allowances and pre-requisites are
dependent on performance appraisal. The criteria should be merit rather than
seniority.
 Employees Development: The systematic procedure of performance appraisal helps
the supervisors to frame training policies and programmes. It helps to analyse
strengths and weaknesses of employees so that new jobs can be designed for efficient
employees. It also helps in framing future development programmes.
 Selection Validation: Performance Appraisal helps the supervisors to understand the
validity and importance of the selection procedure. The supervisors come to know the
validity and thereby the strengths and weaknesses of selection procedure. Future
changes in selection methods can be made in this regard.
  Communication: For an organization, effective communication between employees
and employers is very important. Through performance appraisal, communication can
be sought for in the following ways:

Through performance appraisal, the employers can understand and accept skills of
Page | 49 subordinates.

 The subordinates can also understand and create a trust and confidence in superiors.
 It also helps in maintaining cordial and congenial labour management relationship.
 It develops the spirit of work and boosts the morale of employees.

All the above factors ensure effective communication.

 Motivation: Performance appraisal serves as a motivation tool. Through evaluating

performance of employees, a person’s efficiency can be determined if the targets are
achieved. This very well motivates a person for better job and helps him to improve
his performance in the future.

Performance appraisal tools : Following are the tools used by the organizations for
Performance Appraisals of their employees.

o Ranking
o Paired Comparison
o Forced Distribution
o Confidential Report
o Essay Evaluation
o Critical Incident
o Checklists
o Graphic Rating Scale
o BARS
o Forced Choice Method
o MBO
o Field Review Technique
o Performance Test
Ranking Method

The ranking system requires the rater to rank his subordinates on overall performance.
This consists in simply putting a man in a rank order. Under this method, the ranking of
an employee in a work group is done against that of another employee. The relative
position of each employee is tested in terms of his numerical rank. It may also be done by
ranking a person on his job performance against another member of the competitive
group.

Advantages of Ranking Method

 Employees are ranked according to their performance levels.

 It is easier to rank the best and the worst employee.
 Limitations of Ranking Method

 The “whole man” is compared with another “whole man” in this method. In practice,
it is very difficult to compare individuals possessing various individual traits.
 This method speaks only of the position where an employee stands in his group. It
Page | 50 does not test anything about how much better or how much worse an employee is
when compared to another employee.
 When a large number of employees are working, ranking of individuals become a
difficult issue.
 There is no systematic procedure for ranking individuals in the organization. The
ranking system does not eliminate the possibility of snap judgements.
Forced Distribution method

This is a ranking technique where raters are required to allocate a certain percentage of rates
to certain categories (eg: superior, above average, average) or percentiles (eg: top 10 percent,
bottom 20 percent etc). Both the number of categories and percentage of employees to be
allotted to each category are a function of performance appraisal design and format. The
workers of outstanding merit may be placed at top 10 percent of the scale, the rest may be
placed as 20 % good, 40 % outstanding, 20 % fair and 10 % fair.

Advantages of Forced Distribution

 This method tends to eliminate raters bias

 By forcing the distribution according to pre-determined percentages, the problem of
making use of different raters with different scales is avoided.

Limitations of Forced Distribution

 The limitation of using this method in salary administration, however, is that it may
lead low morale, low productivity and high absenteeism.
 Employees who feel that they are productive, but find themselves in lower grade(than
expected) feel frustrated and exhibit over a period of time reluctance to work.
Critical Incident techniques

Under this method, the manager prepares lists of statements of very effective and ineffective
behaviour of an employee. These critical incidents or events represent the outstanding or poor
behaviour of employees or the job. The manager maintains logs of each employee, whereby
he periodically records critical incidents of the workers behaviour. At the end of the rating
period, these recorded critical incidents are used in the evaluation of the worker’s
performance. Example of a good critical incident of a Customer Relations Officer is : March
12 - The Officer patiently attended to a customers complaint. He was very polite and prompt
in attending the customers problem.

Advantages of Critical Incident techniques

 This method provides an objective basis for conducting a thorough discussion of an
employees performance. This method avoids recency bias (most recent incidents are too
much emphasized)

Limitations of Critical Incident techniques

Page | 51
 Negative incidents may be more noticeable than positive incidents.
 The supervisors have a tendency to unload a series of complaints about the
incidents during an annual performance review sessions.
 It results in very close supervision which may not be liked by an employee.
 The recording of incidents may be a chore for the manager concerned, who
may be too busy or may forget to do it.
Checklists and Weighted Checklists

In this system, a large number of statements that describe a specific job are given. Each
statement has a weight or scale value attached to it. While rating an employee the supervisor
checks all those statements that most closely describe the behaviour of the individual under
assessment. The rating sheet is then scored by averaging the weights of all the statements
checked by the rater. A checklist is constructed for each job by having persons who are quite
familiar with the jobs. These statements are then categorized by the judges and weights are
assigned to the statements in accordance with the value attached by the judges.

Advantages of Checklists and Weighted Checklists

 Most frequently used method in evaluation of the employees performance.

Limitations of Checklists and Weighted Checklists

 This method is very expensive and time consuming

 Rater may be biased in distinguishing the positive and negative questions.
 It becomes difficult for the manager to assemble, analyze and weigh a number of
statements about the employees characteristics, contributions and behaviours.

PERFORMANCE APPRAISAL BIASES

Managers commit mistakes while evaluating employees and their performance. Biases and
judgment errors of various kinds may spoil the performance appraisal process. Bias here
refers to inaccurate distortion of a measurement. These are:

1. First Impression (primacy effect): Raters form an overall impression about the ratee
on the basis of some particluar characteristics of the ratee identified by them. The
identified qualities and features may not provide adequate base for appraisal.
2. Halo Effect: The individual’s performance is completely appraised on the basis of a
perceived positive quality, feature or trait. In other words this is the tendency to rate a
man uniformly high or low in other traits if he is extra-ordinarily high or low in one
particular trait. If a worker has few absences, his supervisor might give him a high
rating in all other areas of work.
3. Horn Effect: The individual’s performance is completely appraised on the basis of a
negative quality or feature perceived. This results in an overall lower rating than may
 be warranted. “He is not formally dressed up in the office. He may be casual at work
too!”.
4. Excessive Stiffness or Lenience: Depending upon the raters own standards, values
and physical and mental makeup at the time of appraisal, ratees may be rated very
strictly or leniently. Some of the managers are likely to take the line of least resistance
Page | 52 and rate people high, whereas others, by nature, believe in the tyranny of exact
assessment, considering more particularly the drawbacks of the individual and thus
making the assessment excessively severe. The leniency error can render a system
ineffective. If everyone is to be rated high, the system has not done anything to
differentiate among the employees.
5. Central Tendency: Appraisers rate all employees as average performers. That is, it is
an attitude to rate people as neither high nor low and follow the middle path. For
example, a professor, with a view to play it safe, might give a class grade near the
equal to B, regardless of the differences in individual performances.
6. Personal Biases: The way a supervisor feels about each of the individuals working
under him - whether he likes or dislikes them - as a tremendous effect on the rating of
their performances. Personal Bias can stem from various sources as a result of
information obtained from colleagues, considerations of faith and thinking, social and
family background and so on.
7. Spillover Effect: The present performance is evaluated much on the basis of past
performance. “The person who was a good performer in distant past is assured to be
okay at present also”.
1.8.Recency Effect: Rating is influenced by the most recent behaviour ignoring the
commonly demonstrated behaviours during the entire appraisal period.

PERFORMANCE APPRAISAL IN CHC , LAMBI

Nurse’s Name: _______________________________________ License No.

_____________________

This report covers ( ) Jan-Mar ( ) Apr-Jun ( ) Jul-Sep ( ) Oct-Dec

20_______

Date of Employment ___________________ Date Terminated/Resigned ____________________

Name and Position of Immediate Supervisor:

______________________________________________

1. UNIT / TYPE OF NURSING CARE (check all that apply)

( ) Medical Surgical ( ) OR/Recovery ( ) Staffing Agency ( )

ICU
( ) ER ( ) Administrative ( ) Psychiatry ( )
Pediatrics
( ) Chemical Dependency ( ) Home Health ( ) OB/GYN ( )
Nursing Home
 ( ) Other -
__________________________________________________________________________

2. POSITION (check all that apply)

Page | 53 ( ) Supervisor ( ) Staff ( ) Instructor

( ) Charge nurse ( ) Private Duty ( ) Other
____________________________

3. SHIFT/HOURS WORK (check all that apply)

( ) days ( ) nights ( ) evenings ( ) full time ( ) part time – list hours worked each month:
______
( ) PRN - list dates and hours worked during report quarter:
_________________________________

4. ATTENDANCE (respond to each question)

_____ Number of days absent in the past 3 months. Pattern of absence exists? ( ) No ( ) Yes
Explain:

_____ Number of days tardy in the past 3 months. Pattern of tardiness exists? ( ) No ( ) Yes
Explain:

5. QUALITY OF WORK (respond to each question)

( ) Excellent ( ) Satisfactory ( ) Needs Improvement ( ) Unsatisfactory - Explain:

Date of employer’s last Performance Evaluation: _______________

Has an evaluation or counseling session been held with the nurse in the past 3 months? ( ) No
( ) Yes ( ) Written: Provide Copy & Explain ( ) Verbal: Explain:

Have there been any incident reports, complaints, or concerns reported about this nurse? ( )
No ( ) Yes: Provide copy & Explain:

6. MEDICATION DUTIES (respond to each question)

Does this nurse administer medications? ( ) Yes ( ) No.

If yes, are there any restrictions? What types of drugs are administered?
__________________________
If no, does the nurse have access to medications? ( ) Yes ( ) No.
How often are medication records reviewed for accuracy? ___________ ( ) Regularly ( )
Occasionally
 Do you believe the employee is maintaining abstinence from all mood-altering chemicals,
including alcohol and prescription medications? ( ) Yes ( ) No

7. INTERPERSONAL RELATIONSHIPS

Page | 54 With patients: ( ) Very Good ( ) Satisfactory ( ) Needs Improvement - Explain:

With the public: ( ) Very Good ( ) Satisfactory ( ) Needs Improvement - Explain:

With co-workers: ( ) Very Good ( ) Satisfactory ( ) Needs Improvement - Explain:

8. NOTIFICATION OF ORDER

Were you informed of the Consent Order/Order by the nurse? ( ) No ( ) Yes

When?___________
Were you provided with a complete copy of the Consent Order/Order by the nurse? ( ) No (
) Yes
If required by the Order, were you notified of Board approval for this employment? ( ) No (
) Yes

If required by the Order, were you notified of Board approval for this employment? ( ) No (
) Yes

Signature

Date

Title of Evaluator

Agency or Facility

Address

City/State/Zip

Telephone Number

Email Address

EXPLANATIONS / QUESTIONS / CONCERNS / COMMENTS:

…………………………………………………………………………………………………
…………………………………………………………………………………………………
 …………………………………………………………………………………………………
…………………………………………………………………………………………………

II. Checklist for Minimum Requirement of CHCs

Page | 55 INFRASTRUCTURE

(AS PER SPECIFICATIONS) EXISTING REMARKS

Population covered

Specialist services available

Medicine

Surgery

OBG

Paediatrics

NHPs

Emergency services

Laboratory

Blood Storage

Infrastructure
(As per Specifications) Existing Remarks
Area of the Building

OPD rooms/cubicles

Waiting room for patients

No. of beds: Male

No. of beds: Female

Operation theatre

Labour room

Laboratory
 X-ray Room

Blood Storage

Pharmacy

Water supply
Page | 56
Electricity

Garden

Transport facilities

III. Checklist for Audit

Whether Functional as per

Particulars Available Norms

Patient's charter

Rogi Kalyan Samiti

Internal monitoring

External Monitoring

Availability of SOPs/STPs*

IV. Checklist for Monitoring Maternal Health

ANC
Minimum 4 ANC

High Risk pregnancy

Cases with Danger sign and symptoms treated.
No of Caesarian Section (CS) done
Proportion of Caesarian sections out of total deliveries

PNC Visit
Minimum 3 PNC Visits within 1st week of delivery i.e. on 0, 3,7th day.

Are deliveries being monitored through Partograph?

 V. Facility Based Maternal Death Review Form

For Office use Only:

Page | 57 FB-MDR no: Year:

1. General Information
 Address of Contact Person at District and State:
 Residential Address of Deceased Woman:
 Address where Died:
 Name and Address of facility:
 Block:
 District: State
Details of Deceased Woman

i. Name: /Age (years) : /Sex: /Inpatient Number:

ii. Gravida: /Live Births(Para): /Abortions: /No. of Living children:
iii within 42 days of
. Timing of death: During pregnancy/ during delivery/ delivery/
iv. Days since delivery/abortion:

v. Date and time of admission:

vi. Date/Time of death:

3. Admission at Institution Where Death Occurred or from Where It was Reported

i . Type of facility where died:

24 x 7 SDH/RUR
PHC PHC AL District Medical private Pvt Clinic other

HOSPITAL Hospital college/ hospital

Tertiary
Hospital

ii. Stage of pregnancy/delivery at admission:

 Ectopic
Abortion Pregnancy Not In Labour In Labour Postpartum

Page | 58
iii. Stage of pregnancy/delivery when died:
Ectopic
Abortion Pregnancy Not In Labour In Labour Postpartum

iv. Duration of time from onset of complication to admission:

v. Condition on Admission: Stable/Unconscious/Serious/Brought dead/
vi. Referral history: Referred from another centre ? How many centres? Type of
centre?
4. Antenatal Care
 Received Antenatal care or not/
 Reasons for not receiving care/
 Type of antenatal care provided/
 High risk pregnancy : aware of risk factors?/what risk factors?
5. Delivery, Puerperium and Neonatal Information

i. Details of labor :had labor pains or not stage of labor when died duration of labor.

ii. Details of delivery: undelivered/normal/assisted (forceps or vacuum) surgical

intervention (C-section)

iii. Puerperium: Uneventful/Eventful (PPH/Sepsis etc.).

iv. Neonatal Outcome : stillborn/neonatal death immediately after birth/alive at birth/alive

at 7 days.
6. Interventions

Specific medical/surgical procedures/rescuscitation procedures undertaken

7. Cause of Death

a. Probable direct obstetric (underlying) cause of death: Specify:

b. Indirect Obstetric cause of death: Specify:

c. Other Contributory (or antecedent) cause/s: Specify:

d. Final Cause of Death: (after analysis)

 8. Factors
(other than medical causes listed above)
a. Personal/Family

b. Logistics
Page | 59
c. Facilities available

d. Health personnel related

9. Comments on Potential Avoidable Factors, Missed Opportunities and Substandard
care

10. Autopsy

Performed/Not Performed
If performed please report the gross findings and send the detailed report later
11. Case Summary
(please supply a short summary of the events surrounding the death):

12. Form filled by

13. Name
14. Designation
15. Institution and location
16. Signature and Stamp
17. Date
VI. STEPS FOR SAFETY IN SURGICAL PATIENTS (IN
THE PRE-OPERATIVE WARD)
To be done by Surgeon
 History, examination and investigations
 Pre-op orders
 Check and reconfirm PAC findings
 Assess and mention any co-morbid condition
 Record boldly on 1st page of case sheet History of drug allergies
 Blood transfusion
o Sample for grouping and cross-matching to be sent
o Check availability & donation
o Risk of transfusion to be explained to relatives
o Written well informed consent from patient (Counter sign by surgeon)
o Sister in charge of O.T. to be informed in advance regarding the need for special
equipment

SIGNATURE OF SURGEON
 To be done by Staff Nurse
Patient’s consent to be taken
(Counter sign by surgeon)
Part preparation as ordered
Page | 60 Identification tag on patient wrist
Name/Age/Sex/C.R. No/Surgical unit/
Diagnosis
Follow pre-op orders
Antibiotic sensitivity test done

SIGNATURE OF STAFF NURSE

To be done by Anesthetist
 Check PAC findings
 Assess co morbid conditions
 H/O any drug allergy
 Check Consent
SIGNATURE OF ANAESTHETIST