INSTITUTE OF HEALTH MANAGEMENT RESEACH Jaipur, rajsthan

Report On 1. Organization & Management Structure of Uttarakhand 2 .Socio-Economic profile, Health Status & Public Health Infrastructure of Uttarakhand 3. Field visit report of CHC, PHC, SC & District Hospital

SUBMITTED TO:Dr. P.R SODANI

SUBMITTED BY:AARUSHI AASIM RIAZ KHAN ACHINT KUMAR ADITYA SOOD ADITI MATHUR

ANA REHMANI

Organization and Management at State Level

At the State level, there is Governing Body (IAS Officer) headed by the Health Minister. The Executive director is leading the executive committee. There is an additional director for implementation of programs. Governing body: It is that part of state under which all health related program is organized. It is divided into three groups as follows: Director of medical and health; finance controller; director of RAKA. In the state of Uttarakhand, as the technical wing, there are six directors at the Directorate of medical and Health services providing their technical inputs in management of health care services. The six Directors are as follows: Upper Director (Administrative officer); Upper director of Medical and education; Upper director of store; Upper director of health; Upper director of medical treatment; Upper director of employer. The director of medical and health is an IAS Officer under which the following department is working: Upper director(administrator)-under which all administrative work takes place; Upper director(medical education)-it helps to promote the medical education ; Upper director of storeunder this all drug related such as storage and quality related work is done; Upper director of health-it helps to prevent communicable and non-communicable disease, disaster management etc. ;Upper director (medical treatment)-under this all functions related to treatment such as EMRI, Smart card policy, Mobile etc are governed by them; Upper director (employer)-under this some employer are working and some of the engineers are also working. They help to maintain the infrastructure. Upper director of administration is further divided into following groups: Joint Director (Administrative) ;Joint director (Staff Officer); Joint Director (Training); Joint

Director(Dental). An Assistant Director works under administrative director who helps in the court cases and the vehicle storage power and another Legal officer works under the assistant director who helps in the above mentioned tasks. The trainee director has an Assistant director who works for him. And the assistant director of dental works under joint director of dental.

Upper director of medical education: under this, joint director of medical education is working. Under joint director, assistant director of medical education is working and under this medical officer are working. Upper director of store: The department of store is divided into further two more departments: Joint director of drugs and logistics; Drug controller. Upper director of health: This department is further dived into two departments: Joint Director (IDSP): It work on the communicable and non-communicable diseases; Joint Director of Health: It works on the following diseases: Vector born disease and Epidemic disease. Some others works include Disaster Management, Food License and Birth and Death Certificate Registrations. Under the joint director of health two more departments are working: Deputy Director (Birth and Death); Medical Officer. Upper Director of Medical Treatment: It has the following three departments: Joint director of Medical Treatment- Further divided into: Assistant Director and Medical Officer; Joint Director of (PPP): Under this following work is done: EMRI, Smart Card, Health policy, Mobile Van Services; Joint Director of faculty: It is further divided into two groups: Deputy Director of Nursing; Deputy Director of Pharmacy. Director (RAKA):It is divided into following departments: Joint Director RCH-1 (Child health and immunization-IMMCI);Joint Director of T.B; Joint Director of Leprosy; Joint Director of Eye; Joint Director of ICE- Under this IEC officers are working; Joint Director of HIMS; Joint Director of AIDS

DISTRICT LEVEL
UTTARAKHAND has two divisions- GARHWAL and KUMAON, 13 districts, 16,826 inhabited villages and 86 small towns. District level is the link between the state/regional structure on one side and the peripheral level structure CHC/PHC/SC on the other side. ORGANISATIONAL STRUCTURE AND MANAGEMENT AT DISTRICT LEVEL:CMO (chief medical
as

officer) Deputy CMO for urban setup (DCMO) Deputy CMO for rural setup (DCMO) Administrative officer

Medical officer (PHC) LHV (lady health visitor) (SC) CMO (chief medical officer):

Medical Superintendent (CHC)

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

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

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

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

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

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

MOBILE HEALTH CLINIC :

Also called as SEHAT KI SAWARI. This project have started in 2 districts of Uttarakhand : 1. Teheri- launched on 27th October 2005 2. Chamoli launched on 17th October 2004 OBJECTIVE: Its main objective is to initiate health care access to remote areas. MANPOWER: Total manpower used in this isPhysician-1, Pharmacist-1, IEC assistant-1, Nurse-1, Lab technician-1, Attendant-1, Project coordinator-1 , Driver-1.

Table 1: Socio-economic Profile

S.No Socio & Demographic Profile 1. 1.1 1.2 2 3 4 5 6 7 8 8.1 8.2 Total population(in millions) Rural Population Urban Population Decadal Growth (%) Source of Data Census of India 2011 Census of India 2011 Census of India 2011 Census of India 2011 Reference Year 2011 2011 2011 2011 2005 2011 2011 2006 2006 2011 2011 2011 Value 10.116752 7284062 2832690 19.17 31.8 189 963 18 3 79.63 88.33 70.70

Population below poverty line (%) aboututtarakhand.blogspot.com Density (Person per sq. km.) Sex Ratio Schedule Caste Population (%) Schedule Tribe Population (%) Literacy Rate(Person) Literacy Rate(Male) Literacy Rate(Female) Census of India 2011 Census of India 2011 Hunger Project India Hunger Project India Census of India 2011 Census of India 2011 Census of India 2011

Total population of Uttarakhand is slightly more than ten million. The population of state is mainly rural in nature. Schedule caste and Schedule tribe contribute 18% and 3% of total population. Population density is approx half of national density (382/sq.km).Decadal growth is more than national average (17.64%) i.e. population expansion is more in the state. Sex ratio is better than national average of 940. Literacy rate is also better than national average for total (74.04%), male (82.14%) and female (65.46).Overall we can say that the socio economic condition of state is satisfactory with respect to national average, but there is potential of further improvement specially in area of female literacy and poverty reduction in the state.

Table 2: Health Status

S.No Health Indicators 1 2 3 4 5 6 7 Crude Birth Rate Crude Death Rate Total Fertility Rate Maternal Mortality Rate Infant Mortality Rate Child Mortality Rate Neonatal Mortality Rate Source of Data SRS SRS NFHS-3 NFHS-3 SRS NFHS-3 NFHS-3 Reference Year 2007 2007 2006 2006 2007 2006 2006 Value 20.4 6.8 2.6 440 48 57 28

Crude birth rate of Uttarakhand is below national average of 23.1,that means state is doing well in population control. Crude death rate is also below the national average of 7.4.It shows state is doing well in this area also. Total fertility rate is almost equal to the national average of 2.7 & infant mortality rate is below the national average of 55. But the main concern for the state is very high maternal mortality rate (national average is 254), which is almost double of national average. Child mortality rate and neonatal morality rate are below national average and it is in satisfactory condition.

Table 3: Public Health Institution

S.No 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 Public Healthcare Infrastructure Number of District Hospitals(DH) Number of FRUs Number of CHCs Number of PHCs Number of SCs Average Rural Population covered by CHC Average Rural Population covered by PHC Average Rural Population covered by SC Average Rural Area covered by CHC Average Rural Area covered by PHC Average Rural Area covered by SC Average Radial Distance covered by CHC Average Radial Distance covered by PHC Average Radial Distance covered by SC Average Number of Villages covered by CHCs Average Number of Villages covered by PHCs Average Number of Villages covered by SCs Number of SCs per PHC Source of Data Module Module Module Module Module Module Module Module Module Module Module Module Module Module Module Module Module Module Reference Year 2010 2010 2010 2010 2010 2010 2010 2010 2010 2010 2010 2010 2010 2010 2010 2010 2010 2010 Number 18 16 55 239 1756 114732 26403 3575 957.93 220.44 29.81 14.79 6.47 2.60 141 27 4 7

Uttarakhand is a hilly area (92% of total area).So, keeping in mind this when we go through the above table we find that the heath infrastructure of the state is not in good position. Average population covered by all three level of heath institution is low. So, there is need to increase the

number of PHCs, CHCs, SCs in the state. Above table also show that the most of the heath centre are not easily accessible as they are far away and hilly area also make it difficult. That also shows the poor infrastructure in the state.

FIELD VISIT REPORT

Based on the visits made to following places:
1. District Hospital, Dausa 2. Community Health Centre, Bassi 3. Primary Health Centre, Tunga 4. Sub Centre, Madhogarh

1.District Hospital ,Dausa :-At District Hospital level, the god things which we came
across were that overall infrastructure was good, all general surgeries were performed, O.T. was well equipped, neonatal care services were provided. Essential diagnostic & laboratory investigations were carried out like- urine examination, pregnancy tests, hematology, X-ray, ECG, USG, etc. Well equipped blood bank was present & blood donation camps were carried out per month. AYUSH, Yashoda & Priyadarshini services were available. Well maintained pharmacy was present with all kinds of drugs including ayurvedic, homeopathic & unani drugs. Family planning checkups were done by doctors on routine basis through field visits. The provisions for BPL were adequate. The drawbacks we found were that there was no ICU & sterilization room. No pediatric surgeon, no physiotherapist, & no dermatologist was present. Only 1 dental chair was present & that too non-functional. No food is provided to indoor patients, except milk. Labor room was over-crowded with 2-3 patients on each bed, thereby increasing the chances of hospital-borne infections in neonates. Used syringes were disposed undestructed just outside the hospital premises. Waste disposal is not carried out as per government guidelines.

2. Community Health Centre ,Bassi:- At Community Health Centre level, the good
things which we observed were that the specialists were present & the manpower was adequate. Essential laboratory & diagnostic services were available including USG, X-ray, ECG, etc. Waste disposal is done efficiently by the waste management on alternate days. The shortcomings that we came across were that the Blood Bank was nonfunctional; the building was still under construction, overall cleanliness wasnt up to the mark. There was no nursery, no pediatric surgeon & no pediatric sphygmomanometer. The operation theatre was not well -equipped & there was no anesthetist.

3. Primary Health Centre ,Tunga:- At Primary Health Centre level, the good things
which we found were that the medical officer was present, the physician conducts the school health program on monthly basis. There was a fixed day of immunization & sessions were held as per govt. guidelines. All facilities were available like laboratory, labor room & proper storage of vaccines. The drawbacks which we found were that there was no operation theatre. There were no facilities for HIV testing & for the disposal of hospital waste. There was no AYUSH facility & no neonatal ward was present. There were no ambulance services. Pharmacy for drug dispensing & storage was not available. Cleanliness in the labor room was poor.

4.Sub Centre ,Madhogarh:- At Sub Centre level, the good things were that a MPW & an ANM
was present 24hrs. Co-ordinate services with AWWs, ASHA, village health & sanitation committee were carried out. Immunization sessions were carried out as per government guidelines. ORS was given to children suffering from dehydration & diarrhea. Family planning survey was carried out on routine basis. Overall infrastructure was satisfactory.

Observations
1. BPL provisions were adequate. 2. Labs were fully equipped. Special cases & diagnostic tests were referred to SMS, Jaipur 3. Generally, specialists for neonatal care were not present 4. Inadequate neonatal wards with special care facilities 5. Insufficient number of beds in labor room & pediatric wards 6. Neonatal deaths were common at all levels due to ARTs, low birth weights, & malnutrition 7. Increased chances of hospital-borne infections due to improper sanitation 8. HIV counseling was available but ART cases was referred to SMS, Jaipur