Workshop on Quality Services under
NRHM for Faculty of Medical Colleges
of Good Performing States
(2nd to 5th February, 2010)
WORKSHOP REPORT
National Institute of Health & Family Welfare
Baba Gangnath Marg, Munirka, New Delhi-110 067
Workshop on Quality Services under NRHM for Faculty
of Medical Colleges of Good Performing States
(2nd to 5th February, 2010)
Workshop Coordinating Team
Workshop Director
:
Prof. Deoki Nandan
(Director, NIHFW)
Workshop Coordinator
:
Dr. S. Menon
Workshop Co-coordinator :
Dr. Bindoo Sharma/ Dr. Vandana
Bhatnagar
National institute of Health & Family Welfare
Baba Gangnath Marg, Munirka, New Delhi-110 067
(Ph.: 011-26166441, 26165959, 26107773, 26185696,
Fax: 91-11-26101623)
E-Mail: director@nihfw.org
www.nihfw.org
INTRODUCTION
National Rural Health Mission (NRHM) launched in April, 2005 envisages provision of
affordable, equitable and quality health care to the population of India, especially vulnerable
groups. National Rural Health Mission has given the guiding principles and has also listed the
deliverables and service guarantees required to be ensured by health care providers/institutions.
However this needs to be translated to actual good quality service delivery at various levels of
health care delivery system (from village to Tertiary health care institutions).
There has been increasing public concern over the quality of health care in recent years both
because of increasing awareness amongst the population and mushrooming of health care
institutions particularly in the private sector. The quality of health care can be improved by
functional health facilities with skilled personnel providing effective and good quality of services.
Medical Colleges are the intellectual and academic capital of the State. The faculty
members of medical colleges would be expected to provide the intellectual input on how to apply
any program to their state/region, in the context of the needs of their state / region and also
demonstrate how good quality health care services can be provided. They would have to therefore
understand the centre’s program, have thorough knowledge about the health problems and available
infrastructure for health services in their states such that they can adapt the programs for effective
implementation through the existing infrastructure to meet the health needs of the population of the
state.
Important role of medical college is pre-service teaching and training. The faculty members
of medical colleges would have to use not only the textbooks but also ensure that their students
both Under Graduates and Post Graduates do have the knowledge and the skills required for
provision of good quality heath care services and implementing the program for the state’s needs.
Many of the students are likely to work in the private sector in the current situation. This
knowledge and skills would therefore help these future doctors to participate in public health
programs even while working in private or other sectors.
Medical Colleges and their hospitals in addition to having highly academic faculty also have
a large case load which is a major advantage for providing skill up gradation training and enabling
the trainees not only to acquire the skills but also learn to diagnose and treat complications. Thus
Medical Colleges have a major role to play in knowledge and skill up gradation during in-service
training for various service providers. In this their roles may be:
 Training of district and below district level trainers
 Training of MO of PHC/CHC (if necessary).
 Training for specialised skills (as Lap. Sterilisation, MTP, Minilap, NSV etc.)
‘Workshop on Quality Services under NRHM for Faculty of Medical Colleges of good
performing States’ was conducted from 2nd to 5th Feb.2010 in NIHFW, Munirka, New Delhi.
1
Category of Participants
The participants of the workshop were faculty from departments of Obstetrics &
Gynaecology, Paediatrics and PSM of medical colleges few trainees from SIHFWs, HFWTCs and
SHSRC.
General Objective
To orient the faculty members of medical colleges about the provision of good quality
health care services under NRHM so as to enable them to incorporate aspects of quality
appropriately in all their teaching and training activities and collaborate with state/district officials
for improving services at primary and secondary levels of health care.
Specific Objectives:
At the end of the workshop the participants are able to:





Discuss the key strategies and interventions under NRHM
Explain the parameters for accreditation of hospitals
Describe the critical issues relevant to quality of Health and Family Welfare services
Evolve a mechanism to incorporate key quality aspects while teaching various components
of health care services
Orient about quality assurance cells at state and district levels
Workshop Contents:








Overview of NRHM
Accreditation of hospitals
Role of Medical Colleges in quality services
Critical issues relevant to Quality of Health and F.W. Services
Infection Control and Biomedical waste management
Integration and convergence of Health & Family Welfare Services at different levels of
health care delivery system
International Classification of Disease-X
Quality Health and F.W services under NRHM
Duration
:
4 days (2nd to 5th February, 2010)
Number of Participants
: 37 (Annexure-I)
Methodology




Lecture Discussion
Group Work
Participants Presentation
Brain Storming
Evaluation: The workshop was evaluated based on participant’s feedback on structured Performa.
2
Salient Features of the Workshop

The participants represented medical college faculty from deptt. of obstetrics and
gynaecology, PSM and Paediatrics. There were a few trainers from HFWTC/SIHFW and
SHRC. The break up is as follows:
States
Maharashtra
Gujarat
West Bengal
Punjab
Haryana
Chandigarh
Total
Obst. / Gyane
Paed.
PSM
4
1
3
2
4
2
8
2
1
1
1
10
2
9
12

HFWTC/
SIHFW, SHSRC
5
1
6
Total
21
6
3
4
1
2
37
Nominations were received from Govt. and private medical colleges from six states and the
break up is as follows:
States
Name & Address of Medical Colleges
Chandigarh
Govt. Medical College & Hospital, Sector-32, Chandigarh-160030
Gujarat
1) Medical College, Baroda-390001, Gujarat
2) Pramukh Swami Medical College, Karamsad-388325, District Anand,
Gujarat
Haryana
Maharaja Agrasen Medical College, Agroha, Hisar-125047, Haryana
Punjab
1) Christian Medical College & Hospital, Ludhiana-141008, Punjab
2) Govt. College Amritsar-143001, Punjab
Maharashtra
1) Govt. Medical College, Aurangabad-431001, Maharashtra
2) Indira Gandhi Government Medical College (IGGMC), Nagpur440012, Maharashtra
3) MGM Medical College, Kamothe, Navi Mumbari, Distt. Raigad410209, Maharashtra
4) N.K.P. Salve Institute of Medical Sciences & Lata Mangeshkar
Hospital, Digdon Hills, Hingna Road, Nagpur-440019, Maharashtra
5) LTM Medical College, Dr. B.A. Road, Sion, Mumbai (Urban Health
Centre, Dharavi) Mumbai-400022, Maharashtra
6) KEM Hospital & G.S. Medical College, Mumbai-400012, Maharashtra
7) B.J. Medical College, Pune Station Road, Pune-411001, Maharashtra
8) TN Medical College & BYL Nair Hospital, Mumbai-400008,
Maharashtra
West Bengal
1) Calcutta National Medical College (CNMC), 32, Gorachand Road, Park
Circus, Kolkara-700014, West Bengal
2) North Bengal Medical College, Sushrut Nagar, Distt. Darjeeling734012, West Bengal
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Workshop on Quality Services under NRHM for Faculty of Medical Colleges of Good Performing States
(2nd to 5th February, 2010)
Programme Schedule
9.00 AM -9.30 AM
Registration
Tuesday
2.2.2010
9.00 AM – 9.30AM
Recap/experience
sharing
Wednesday
3.2.2010
Thursday
4.2.2010
(Participant)
11.30 AM -1.00 PM
2.00 PM – 4.00 PM*
4.15 PM – 5.30PM
Critical issues in quality of
Health & F.W.Services
Group work
Quality services under
NRHM
Facilitators:
(Dr. S. Menon,
Dr. Bindoo &
(Dr. Vandana)
Overview of NRHM
2.00 PM -3.30 PM
Monitoring and
evaluation under
NRHM
3.45 PM-5.30 PM
9.30 AM- 10.30 AM 10.30 AM -11.15AM
Introduction,
Expectations of
Participants.
Briefing about the
course
(Dr. Bindoo &
Dr. Vandana)
Participant’s
perception about
quality services
under NRHM
(Dr. Bindoo)
Brain Storming
(Dr. S. Menon)
Discussion
9.30 AM– 11.15 AM
Inter-sectoral Convergence
(Dr. Prema Ramachandran)
Lecture discussion
11.30 AM -1.00 PM
Role of Medical college in
quality of care
(Prof. Deoki Nandan)
Discussion
9.00 AM – 09.30 AM
Recap/experience
sharing
9.30 AM – 11.15 AM
Quality Issues in family welfare services
under NRHM
Integrated service delivery
(Participant)
(Dr. Kiran Ambwani)
Discussion
(Dr .K.Kalaivani)
Lecture discussion
9.00 AM – 9.30 AM
9.30 AM – 10.00 AM
Recap/experience
sharing
Brief about National Health Information
Collaboration
10. 00AM – 11.15 AM
Group work (contd)
Quality services under
NRHM
Facilitators:
(Participant)
Dr. Mirambika Mahopatra
Friday
5.2.2010
11.30AM -1.00.PM
(Dr. Menon &
Dr. Bindoo)
Tea time
:
11.15 AM to 11.30 AM; 3.30PM to 3.45 PM
*4.00 PM to 4.15 PM
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(Dr. Rattan Chand)
Lecture discussion
2.00 PM – 3.30 PM
Infection control and
Biomedical waste
management
(Dr. U. Dutta)
Lecture Discussion
Orientation to ICD-X
(Dr. Ashok Kumar)
Lecture Discussion
03.45 PM– 05.30 PM
Accreditation of hospitals for quality
Services
(Mrs. Renuka
Patnaik)
Lecture discussion
11.30AM – 1.00PM
Group work presentation by
Participants
(Prof. J.K. Das)
Discussion
2.00 PM – 3.30PM
Concluding session
(Dr. K. Kalaivani,
Dr. S. Menon,
Dr. Bindoo &
Dr. Vandana)
Lunch :
1.00 – 2.00 PM
Sessional Objectives:
1. Perception about quality services under NRHM:
 To list the various views of the participants regarding quality services.
 To identify the differences in perception of quality services.
2. Critical issues in quality of Health & F.W. services
 Discuss the critical issues relevant to provision of good quality of maternal & child
health, Family planning and disease control services.
3. Quality services under NRHM: (Group Work):
A. Reproductive health Services (Maternal, RTI/STI, contraception, Infertility etc.)
B. Child health services including newborn care. (Preventive and curative Services).
C. Communicable and non-communicable diseases health care services. (Preventive and
curative Services)
D. Development of supervisory checklist for quality services during Village Health and
Nutrition day.
Terms of Reference (TOR) for Group Work:




Enumerate the outdoor as well as inpatient services relevant to group work.
List the quality issues relevant to the services.
Explain a mechanism for addressing the quality issue.
Discuss how Medical colleges can develop linkages or mechanism to improve the service
delivery at all levels of health care delivery (from village level to district levels)
4. Overview of NRHM:
 Enumerate the key strategies under NRHM.
 Explain various interventions under NRHM.
5. Inter-sectoral Convergence:
 Describe the mechanism of inter-sectoral convergence under NRHM.
 Explain how inter-sectoral convergence improves quality of services.
6. Role of Medical College in quality of care:
 Explain what is quality of Care.
 Describe the role of medical college in quality of care.
7. Monitoring and evaluation under NRHM:
 Explain the mechanism of monitoring and evaluation under NRHM.
 Discuss importance of NFHS, DLHS data.
8. Orientation to ICD-X:
 Explain the rationale of ICD-X.
 Discuss the importance of ICD-X.
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9. Quality issues in family welfare services under NRHM:
 Explain quality of care for maternal ,child health and Family planning services
 Describe the mechanism of quality assurance for family welfare Services.
10. Integrated service delivery:

Describe the mechanism of integrating the services at various levels of Health care delivery
system
11. Infection control and Biomedical waste management:
 Discuss the Infection prevention and control measures.
 Explain the standard Precautions.
 Describe the procedures relevant to biomedical waste management.
12. Accreditation of hospitals for quality Services:
 Explain the importance of accreditation of hospitals.
 Describe the parameters/criteria for accreditation of hospitals under NRHM.
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WORKSHOP PROCEEDINGS
Day 1:
2/2/2010
The workshop started with the self introduction by participants and workshop coordinators. The
participants were asked to write down their expectations from the workshop. The expectations are
listed in Annexure-IV.
Most of participants had the following expectations:
1. How to incorporate quality services in the medical college
2. Newer interventions under NRHM
Participant’s Perception about Quality Services under NRHM
The session was conducted by Prof. S. Menon, who asked the participants to explain their
perception of quality. She explained that for everyone the perception may be different. The
participant’s perceptions are given in Annexure-V.
The following issues were highlighted:

Quality is quantifiable

Perception depends on the interest of the participants.

Benchmark standard should be set and once it is reached then a higher standard should be
set.
Highlights
 Most of the participants felt that client’s satisfaction is the major parameter of quality.
 Only 4 participants felt that performance to standards is an important benchmark of quality
Critical issues in quality of Health & F.W. services
This session was taken by Dr. Bindoo by the brainstorming method. All the participants were
divided into three groups and were asked to identify critical issues in provision of:
 Maternal Health services
 Child Health Services.
 Service environment favorable for Good Quality Services.
Each group was asked to discuss amongst themselves and present the observations which were
discussed amongst all the participants. The presentation (s) is included as Annexure-VI.
There were a few cross cutting issues like:
Issues
Accessibility, Affordability & Accreditation
Behaviour of service providers
Continuity of services
Delays and equity
Strategies under NRHM
Architectural correction
Behaviour change communication
Citizens charter
Differential strategy
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Group Work Quality Services under NRHM:
For group work the participants were divided into 4 groups by the facilitators. Each group consists
of representatives from different states and specialties viz maternal health, child health, community
medicine and from training centre. The presentations made by participants are given in AnnexureVIII.
Overview of NRHM
During the session on Overview of NRHM Dr. U. Datta talked about the vision of NRHM. He
enumerated the goals of NRHM which includes providing universal access to equitable, affordable
and quality health care services, responsive to the needs of the people. He explained the expected
outcomes of NRHM at the community level. He talked of how to improve the Public Health
Delivery System. He explained how decentralization and convergence is being implemented in the
country.
He explained about the architectural corrections and the funding under NRHM. He discussed about
the new strategies under NRHM.
Highlights
 Improving public health delivery system, convergence, decentralization and architectural
corrections as per IPHS are some of the interventions under NRHM.
 For improving public health delivery system capacity building of PRIs, PMSUs and health
professionals is one of the steps.
Day II: 3/2/2010
Experience Sharing (Annexure-VII)
Dr. Arun Humne
He shared the experience related to evaluation of mother NGOs and field NGOs under NRHM,
funded by State Health Systems Resource Centre, Pune. It was suggested that this could be
reproduced by others so that the medical college will be able to use their manpower for reaching
out to the public within the system.
Dr. R.R. Shinde spoke about
Establishing Integrated Disease Surveillance Programme (IDSP) in the hospital involving clinical
departments coordinated by PSM department.
IDSP is one of the flagship program of Government of India, promoting quality data management
in disease surveillance. The focus is on ensuring uniformity, standardization, reliability, accuracy,
consistency & diligency in disease data collection, compilation, analysis and public health
applications.
The faculty of PSM and resident doctors conduct a preventive OPD in KEM Hospital daily. All
new patients & patients on chronic management are first referred to preventive OPD. The
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preventive OPD undertakes screening, counseling, health education, treatment of uncomplicated
cases.
The Medicine & Paediatrics OPD is on the same floor and hence, where essential, immediate
escorted referral of cases is possible.
This has facilitated cooperation & active participation of clinical faculty in IDSP. At institutional
level, PSM department has assertively introduced role of PSM faculty as “Doctors of Health” and
role of clinical specialists as “Doctors of Disease”. In public health terms, clinicians are now
referred as specialists of secondary & tertiary prevention.
Inter-sectoral Convergence:
In this session Dr. Prema Ramachandran explained that there quantifiable determinants &
ingredients of quality which include infrastructure/manpower, processes for diagnosis & treatment,
safety & timeliness of interventions outcome and cost of care. She explained the pre-requisites of
good quality of services.
She explained that convergence will result in provision of quality services by ensuring better
coverage, content and timeliness. She further explained how synergy between AWW, ASHA &
ANM can help to ensure better safe abortion services, better Antenatal care, increased institutional
delivery and management of malnutrition. She talked of how the convergence between vertical
health programmes and RCH can help to achieve integrated services. She described the Antenatal
card developed by ICDS which was distributed to all the participants of the workshop. She
explained how to standardize the weighing machine for accurate measurement of the change in
weight and for estimation of BMI. She cautioned that most of the ‘weight for height cards’ are
developed by the western world. She ended by informing the participants about the advantage of
estimating BMI for cards identification of both under & over nutrition.
Highlights
 Intra- sectoral convergences between different health sector programmes Inter-sectoral
coordination between health, nutrition, education, water supply sanitation and other
related sectors has synergistic effect and improves performance in all the sectors. It is
essential that efforts are made to ensure that coordination occurs at all levels especially
during implementation at or below district level
 integrate the activities related to procurement, logistics of supply, training, IEC, HMIS
under different vertical programmes;
Role of Medical College in Quality of Care:
In the session the Director explained to look into the need of the citizens of the country and work
for their benefit. He said that knowledge, analysis, planning etc. should be for the people’s benefit
and not just of academic importance. He also said that some states like Bihar, UP, MP and West
Bengal need to have more Medical Colleges and the medical colleges should realize their
responsibilities towards the rural India.
9
He stated that Medical Colleges and the Medical College Hospitals given their vast and diverse
case load and the experienced expert faculty should be the best skill up - gradation training centres.
The Medical Colleges can ensure that their undergraduate and postgraduate students as well as
participants in training courses understand the rationale, components as well as strategies of all the
programs ,also ensure that they do have the knowledge and the skills required for implementing the
program for the state’s needs.
The Medical College Hospitals should act as Apex Training Centres by practicing the program
components in National Training Strategy for In-service Training under National Rural Health
Mission and their routine service delivery, thereby, enabling the post graduate and under graduate
students to practice & achieve all the skills required pre-service.
He added that there should be paradigm shift in curriculum and issues like Mainstreaming AYUSH,
Telemedicine/ICT, Tobacco Control, Patients Rights in health, Standard treatment guidelines, ICD
-10 Classification, Revitalizing Primary Health Care and Stress Management should be included.
Some of the deficient areas like Counseling skills, Quality issues, Elementary Nursing practices &
Geriatric Care should be strengthened.
He concluded by giving an example how the first years may be posted in the wards, listen to
conversation of patients and relatives to learn social behaviour/concerns.
Highlights
 Medical Colleges should not be viewed in isolation
 The Medical Colleges can ensure that their undergraduate and postgraduate students as
well as participants in training courses understand the rationale, components as well as
strategies of all the programs ,also ensure that they do have the knowledge and the skills
required for implementing the program for the state’s needs.
 Integrated/ multi-disciplinary teaching and enabling environment
Monitoring and Evaluation under NRHM
Dr. Rattan Chand talked about Monitoring and Evaluation. He described about DLHS and it is
concurrent evaluation of NRHM through independent agencies like IIPS.


District wise indicators on CBR, CDR, IMR
MMR for a group of districts
He informed that Indicators to be covered in Annual Health Surveys (AHS) finalized in meeting of
the Steering Committee held on 9th September, 2009. A Technical Advisory Group (TAG) has
been constituted under the chairmanship of Dr. N.S. Sastry, Ex-DG NSSO to finalize survey
instruments. The Annual Health Survey is expected to be launched by March 2010 and results
expected by early 2011. Regarding HMIS he stated that:

Formats finalized in consultation with program divisions

Separate facility level formats

Information flow has changed from paper to electronic form

HMIS portal has been launched and is functional.
10
He cautioned about the need to validate data received from different sources like HMIS, surveys
etc. He said Expert Group needed to guide triangulation activities has been established and data
triangulation work on MCH and FP is under progress.
Highlights
 Indicators to be covered in AHS finalized in meeting of the Steering Committee held on
9th September, 2009
 Survey expected to be launched by March 2010 and results expected by early 2011
 Expert Group to guide triangulation activities established
 Data triangulation work on MCH and FP under progress.
Orientation to ICD-10
This session was conducted by Dr. Ashok Kumar. He explained the need of International
classification of Disease-10 (ICD-10) and enumerated some of the initiatives taken in the country to
promote the use of ICD-10. He informed that Central Bureau of Health Intelligence (CBHI) has
prepared and released the Module & Workshop-Orientation Training on ICD-10 for distribution to
the trainees as reference and self learning module. This module has been updated and reprinted in
2008. Certain initiatives taken by CHBI towards manpower development are:

Request to Director General of (i) Armed Forces Medical Services, (ii) Railways Health
Services and (iii) ESI, for appropriately ensuring the use of the ICD-10 in their respective
medical and health care institutions and develop the trained manpower.

In 2008, Based on the need, the orientation on International Classification of Functioning
Disability & Health (ICF) in India was integrated with the orientation training on ICD-10 as
devised by the experts during National Workshops, 18th November & o4 -05th December,
2008 and updated to the “Orientation Training Course on FIC (ICD-10 &ICF)”, one week,
separately, for Master Trainers and Non-Medical Functionaries.

CBHI has already institutionalized orientation training on Functionaries of IRDA and
Health Insurance Companies in India-FIC (ICD-10 & ICF) through its various training
centers in different regions of the country
Highlights
 ICD-10 coding system be implemented throughout the country for comparison at both,
national and international levels and the use of ICD-10 be concurrently monitored by
hospital administration for timely corrective measures at various levels, including meeting
the ICD-10 trained manpower needs
 All the Government Allopathic Medical Colleges and Medical Council of India have been
requested and being pursued to ensure appropriate teaching and skill on use of ICD-10 as
part of the under- graduate and post- graduate degree curricula.
Day III: 4/2/2010
Experience Sharing
Dr. Dinesh Bhanderi shared his experience on “Evaluation of the government health care services
provided to women in reproductive age and children under three years age in Anand district. The
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observations included that in small & remote villages, the distribution of ‘Mamta card’ is not
satisfactory, visits by FHW & supervisory staff were also very less than desired and Mamta card
was not used adequately for educating the women regarding nutrition, warning signs, self-care &
newborn care. The recommendations included that IEC activities to create awareness regarding
various government programmes and schemes need to be strengthened so as to maximize their
utilization by the beneficiaries and Mamta card should be extensively used for education &
counseling of pregnant women & mothers.
Quality Issues in Family Welfare Services under NRHM
The session was conducted by Dr. Kiran Ambwani who talked about the various dimensions of
quality services and the steps taken to improve RCH services. She elaborated on quality assurance
committee and quality circles. She informed how quality council of India is supporting GOI in
adapting quality standards at different levels and conducting awareness seminars. She shared
experiences of different state in improving quality. she summarized by reminding that quality
requires setting and achieving standards of service availability to all and that GOI support is
available for states to take initiatives.
Highlights
 Dimensions of quality include perceptions of service provider, client (user) and the service
environment
 Focus on Quality is essential for achieving National Health Goals & ensuring
sustainability and credibility of Public Health Systems;
 Support of GOI available for States to take initiatives.
Integrated Service Delivery
The session was conducted by Prof. K. Kalaivani who described the current practices of service
provision with their disadvantages e.g. Immunisation and MCH services are provided on separate
days. This implies that the women needs to come twice for seeking services i.e. for immunisation,
contraception etc., which has direct implications on their time lost for work and wages. She
informed that the proposed strategy in NRHM to ensure provision of services at periphery in all
villages which is the village health and nutrition day. She enumerated the services to be provided at
the AWC during the VHND.
Highlights
 The work schedule is not displayed in the sub-centre or PHCs or in the community, people
remain unaware of the services being provided and also the availability MPHW (M&F) in
the village on a particular day.
 There is lack of clarity in job responsibility of MPHW(M&F), which clearly leads to non
performance of work as well as low quality of services provided.
12
Infection Control & Biomedical Waste Management
The session was conducted by Mrs. Renuka Patnaik who informed that infection prevention means
prevention of occurrence of infection and minimization of risk of transmitted infection while
providing services for contraception, childbirth, newborn care, post natal care, etc. She pointed out
that all objects coming in contact with patients should be considered potentially contaminated. She
explained the difference between disinfection, decontamination, cleaning and asepsis. She gave
examples from her monitoring visits.
Highlights
 Minimization of risks of transmitting infection while providing services for contraception,
childbirth, newborn care, post-natal care, immunization, post-abortion care and
management of RTIs/STIs.
 To address these issues, an Infection Management and Environment Plan (IMEP) has been
formulated by the MOH&FW, GOI with the aid of DFID India
 Operational Guidelines designed for easy utilization by healthcare workers at CHCs,
FRUs, PHCs and SCs with simple instructions and pictorial presentation of infection
control and waste management procedures
Accreditation of Hospitals for Quality Services
Prof. J.K. Das informed that Accreditation is now a world trend in health care and that accreditation
benefits are patients, community and hospital as well as employees. Internationally the best-known
focused accreditation programmes are WHO/UNICEF’s Baby Friendly and Mother Friendly
Hospital initiatives. Accreditation or other EQA programmes are most likely to successfully
improve quality if they are voluntary and exist in conjunction with enforced governmental licensure
that assures minimum standards.
The process of accreditation is includes initial application including self assessment as per the laid
down standards, screening of the application followed by assessment survey and accreditation
committee recommendations.
Highlights
 Accreditation process encourages those that are doing the best work, and stimulates those
of inferior standards to do better.
 The most effective means of providing long-term support for an accreditation / EQA
programme is indirect, by establishing financial incentives for organizations to participate.
Day IV: 5/2/2010
Experience Sharing
1. Dr. Gautam Mukhapadhyay talked about the role of injection magsulf in the treatment of
ecclampsia. He said that gradual persuasion and use of low dose magsulf in the periphery
has resulted in decreasing the morbidity of ecclampsia.
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2. Dr. Seema Ananjaya shared her experience regarding provision of integrated teaching in the
under graduate in the second year MBBS students. She explained how integration is being
done between the departments of PSM, paediatrics, obstetric. She said that the study will be
completed in April 2010 in order to evaluate the outcome of integrated teaching in the
community. The topics covered include breastfeeding, PEM and malnutrition.
3. Dr. A.P. Kulkarni spoke about his experience in finalization of the PIP for Maharashtra. He
informed the group during his career at the Medical College there were lot of issues about
which he was not aware. After joining SHRC, Pune he has realized the spectrum of issues
which need to be addressed by Medical College faculty as well.
The participants gave suggestions for involvement of medical college faculty in NRHM (AnnexureIX)
Dr. Mirambika, From NIHFW
She demonstrated the portal for National Health Information Collaboration (NHIC) to the
participants. The participants felt that there should be strict rules for including articles at the NHIC.
Some of the participants visited the computer centre of the institute for practicing the use of this
portal.
Presentation on Group Work
All the four groups presented their group work to Prof. Menon. All the group’s presentations were
appreciated. However, the following issues were raised:
 Presentation on disease control addressed the issues of quality services in the tertiary centres
predominantly.
 The checklist in the village health and nutrition day did not include any experience of the
group.
Concluding Session
The valedictory session was chaired by Dr. M. Bhattacharya, Dean of Studies who asked the
participants to explain what were the additions in their knowledge following the workshop. Dr.
Sushma Malik (Pead) informed that there were so many interventions under NRHM about which
she was not aware and she was happy to learn about them. Similarly Dr. Bhosale (Obst./Gynae) felt
the experience sharing was another strong feature of the workshop. Suggestions to involve medical
colleges in NRHM were taken from the participants and is included as Annexure-IX.
Dr. Dinesh Bhanderi gave a brief on the sessional evaluation which is included as Annexure-X (A).
He clarified that most of the sessions were satisfactory but suggestions were given for improvement
in most of the sessions which are included.
The workshop evaluation was done by Dr. Shinde and the workshop evaluation is included as
Annexure-X (B) in which suggestion for improvement have been included as well. The participants
found the workshop to be democratic, informative and helpful.
14
Workshop on Quality Services under NRHM for Faculty of Medical Colleges of
Good Performing States (2nd to 5th February, 2010)
List of Resource Persons
S. Name
No.
External:
1. Dr. Ashok Kumar
Designation
Ph/Fax No.
E-Mail ID
Dy. Director General &
Director,
Central Bureau of Health
Intelligence Dt. General of
Health Services, Room No.
401 & 404-A Wing, Nirman
Bhawan, New Delhi-110 011
(O) 011-23062695 dircbhi@nic.in
23061529
(F) 011-23063175
(M) 9868891147
2.
Dr. Kiran Ambwani DC (F.P.)
Room No. 311-D, MOHFW,
Nirman Bhawan, New Delhi
3.
Dr. Rattan Chand
CD (Statistics)/ CD (M&E), (O) 011-23062699 cdstat@nb.nic.in
Room No. 243-A, Nirman
Bhawan, Maulana Azad Marg,
New Delhi-110 011
4.
Dr. Prema
Ramachandran
Director, NFI & Former
(M) 9891485605
Advisor (Health) Planning
Commission
Nutrition Foundation of India
C-13, Qutab Institutional Area
New Delhi - 110 016, India
Internal :
1. Prof. Deoki Nandan Director, NIHFW, New
Delhi
2.
3.
4.
5.
6.
7.
8.
(O) 011-23062485 kambwani@rediffmail.c
Ext/ 2789/ 464
om
(F) 23062485
011-26165959
Ext – 301, 302
011-26101623 (Fax)
Prof. K. Kalaivani
HOD, RBM and Nodal
011-26165959
Officer, NRHM/RCH ,
Ext – 330, 333
NIHFW
011-26160158(Fax)
Dr. S. Menon
Professor ,Deptt. of RBM, 011-26165959
Asst. Nodal Officer,
Ext – 125, 387
NRHM/RCH, NIHFW.
011-26160158 (Fax)
Prof. J.K. Das
HOD, Epidemiology,
011-26165959
NIHFW, New Delhi
Ext – 307
Prof. U. Dutta
HOD E&T, NIHFW, New 011-2616595
Delhi
Ext-314
Dr. Bindoo Sharma Sr. Consultant – RCH,
011-26165959
NIHFW
Ext – 376
Mrs. Renuka Patnaik Consultant, RCH, NIHFW 011-26165959
Ext – 367
Dr. Vandana
Consultant - RCH,
011-26165959
Bhatnagar
NIHFW
Ext – 238
15
premaramachandran@g
mail.com
director@nihfw.org
dnandan51@yahoo.com
dnandan@nihfw.org
rchtrg@gmail.com
kalaivanikrishnamurthy
@gmail.com
smenon30@gmail.com
rchtrg@gmail.com
jkdas.nihfw@nic.in
utsuk@rediffmail.com
rchtrg@gmail.com
rchtrg@gmail.com
rchtrg@gmail.com
Annexure-I
Workshop on Quality Services under NRHM for Faculty of Medical Colleges of
Good Performing States (2nd to 5th February, 2010)
List of Participants
S.
Name & Designation
No.
Chandigarh
1. Dr. Kana Ram Jat
(M.D. Pediatric)
Asst. Professor
2.
Dr. Geetanjali Jindal
(M.D. Pediatric)
Asst. Professor
Gujarat
3. Dr. Omprakash Shukla
(M.D. Pediatric)
Asso. Professor
Department
Pediatrics
Pediatrics
Pediatrics
Office Address
Phone Nos. / Fax
Govt. Medical
College & Hospital,
Sect.32, Chandigarh160030
Govt. Medical
College & Hospital,
Sect.32, Chandigarh160030
M: 9646121525
Res : 9872308656
vishal_guglani@yahoo.com
drkanaram@gmail.com
M: 9646121595
Res : 2624222
vishal_guglani@yahoo.com
geetanjali_jindal@yahoo.co.
in
Medical
College,
Baroda-390001,
Gujarat
Pramukh Swami
Medical College,
Karamsad-388325,
District Anand,
Gujarat
Pramukh Swami
Medical College,
Karamsad-388325,
District Anand,
Gujarat
Pramukh Swami
Medical College,
Karamsad-388325,
District Anand,
Gujarat
Medical
College,
Baroda-390001,
Gujarat
Off : 02652422883
M : 9426370860
opshukla101@yahoo.co.in
Off : 02692222130
M : 09825197277
psmc@charutarhealth.org
dr_nitin_raithatha@yahoo.c
om
nitinsr@charutarhealth.org
4.
Dr. Nitin Raithatha
(M.D. Gynae)
Asso. Professor
Obst. &
Gynae.
5.
Dr. Dipen Patel
(M.D. Pediatrics)
Asst. Professor
Pediatrics
6.
Dr. Dinesh Bhanderi
(M.D. Community
Medicine)
Asso. Professor
PSM
7.
Dr. Navnit Padhiyar
(M.D.)
Asst. Professor
PSM
8.
Dr. Kiritkumar Ratilal
Shah
(MBBS)
M.O. (Epidemiologist)
Epidemiolo
gy
SIHFW, S.G.
Highway, Sola Civil
Hospital,
Ahmedabad-380060,
Gujarat
Off : 07927662811
Res : 07926440809
Fax: 079-27665964
PSM
Maharaja Agrasen
Medical College,
Agroha, Hisar125047, Haryana
Off : 01669281193
Ext.: 264
Off : 01669281176
M : 9896247710
Haryana
9. Dr. Seema Choudhary
(M.D., Community
Medicine)
Asso. Professor
Community Medicine
E-mail Address
16
Off : 02692222130
Res : 02764265269
psmc@charutarhealth.org
Off : 02692222130
Res : 02692231721
psmc@charutarhealth.org
bhanderi1963@gmail.com
Off : 026512427545
Res: 9228186060
M: 9427226707
navneet_padhiyar@yahoo.c
o.in
krshah22@gmail.com
profseemachoudhary@yaho
o.co.in
S.
Name & Designation
No.
Punjab
10. Dr. Geetika Dheer
(M.D. Pediatrics)
Asst. Professor
11. Dr. Ashok Salwan
(M.D., MBBS, DGO)
Asst. Professor
12. Dr. Pratibha Dabas
(M.D., MBBS)
Asst. Professor
Community Medicine
13. Dr. Moneet Walia
(M.D., MBBS)
Asst. Professor
Maharashtra
14. Dr. Mohan K. Doibale
(M.D. PSM)
Asso. Professor
Department
Office Address
Phone Nos. / Fax
Pediatrics
Christian Medical
College & Hospital,
Ludhiana-141008,
Punjab
Off : 01612229010
M : 9872206670
Obst. &
Gynae.
Govt. Medical
College Amritsar143001, Punjab
Christian Medical
College & Hospital,
Ludhiana-141008,
Punjab
Christian Medical
College & Hospital,
Ludhiana-141008,
Punjab
Res: 0183-3299760
M: 9915068181
PSM
Obst. &
Gynae.
PSM
15. Dr. Anita Banerjee
(M.D. Pediatrics)
Lecturer
Pediatrics
16. Dr. Seema Anjenaya
Professor & Head
PSM
17. Dr. Madhukar S. Pawar
(MBBS, DPH, MD)
Principal
PSM
(HFWTC)
18. Dr. Sudhakar B. Kokane
(MBBS, DPH)
Principal
HFWTC,
Pune
19. Dr. Vijay Kamale
Professor
Pediatrics
20. Dr. Pankaj Patil
(M.D.)
Obst. &
Gynae.
Off: 0161-6450829
M: 9780243695
Off: 016122290101
M: 9876020475
E-mail Address
drtenjinder@rediffmail.com
drgdheer@gmail.com
doctorpratibha@gmail.com
navmalwai@yahoo.com
Govt. Medical
Off : 0240doibale@gmail.com
College, Aurangabad- 2402424
431001, Maharashtra Res : 02402354393
Fax : 02402402418
M: 09422203393
Indira Gandhi
M: 9881010321
dr.anitabanerjee@gmail.com
Government Medical
College (IGGMC),
Nagpur-440012,
Maharashtra
MGM Medical
Off : 022-2742
drseema23@rediffmail.com
College, Kamothe,
7997
Navi Mumbari, Distt. Res : 0251Raigad-410209,
2202170
Maharashtra
M: 9821661558
Health & Family
Off : 0253hfwtcnsk@rediffmail.com
welfare Training
2311201
Centre, Nashik, Civil Res : 0253Hospital Campus,
2575108
Nasik-422001,
Fax: 0253-2311201
Mumbai
Health & Family
Off : 020hfwtcpune@yahoo.com
welfare Training
27281255
sbk2015@yahoo.co.in
Centre, Aundh
Res : 020Campus, Pune25453171
411027, Mumbai
Fax: 020-27281255
M: 09422021581,
09867218951
MGM Medical
Off : 022drvijaynkamale@yahoo.co.i
College, Kamothe,
27423404
n
Navi Mumbari, Distt. Res : 022Raigad-410209,
64217771
Maharashtra
M: 9224475712
MGM Medical
Off : 022Patilp68@yahoo.com
College, Kamothe,
27427997
mgmmcnb@gmail.com
17
S.
No.
Name & Designation
Department
Asst. Professor
21. Dr. Anjali Edbor
(M.D. Pediatrics)
Asso. Professor
Pediatrics
22. Dr. Pallavi S. Shelke
(M.D., DPH, DNB,
MPS)
Asso. Professor
PSM
23. Dr. Ratnendra Ramesh
Shinde
(M.D.)
Prof.& Head
PSM
24. Dr. Rajan N. Kulkarni
(MBBS, DPH, M.D.)
Asso. Professor
PSM
25. Dr. Payal Laad
(MBBS, M.D.)
Asst. Professor
PSM
26. Dr. Ramesh A. Bhosale
(M.D.)
Professor
Obst. &
Gynae.
27. Dr. Shailesh Deshpande
(M.D. PSM)
Sr. Consultant (Research
& Documentations)
PSM
28. Dr. Deepak Phalgune
(M.D. PSM, Ph.D)
Sr. Consultant
RCH, CTIPSM
Office Address
Navi Mumbari, Distt.
Raigad-410209,
Maharashtra
N.K.P. Salve Institute
of Medical Sciences
& Lata Mangeshkar
Hospital, Digdon
Hills, Hingna Road,
Nagpur-440019,
Maharashtra
Lokmanya Tilak
Municipal Medical
College, Deptt. of
PSM, Dr. B.A. Road,
Sion, Mumbai (Urban
Health Centre,
Dharavi) Mumbai400022, Maharashtra
G.S. Medical College,
Deptt. of PSM, 3rd
Floor, Library Bldg.
Parel, Mumbai400012, Maharashtra
G.S. Medical College,
Deptt. of PSM, Parel,
Mumbai- 400012,
Maharashtra
Lokmanya Tilak
Municipal Medical
College, Deptt. of
PSM, Dr. B.A. Road,
Sion, Mumbai (Urban
Health Centre,
Dharavi) Mumbai400022, Maharashtra
B.J. Medical College,
Pune Station Road,
Pune-411001,
Maharashtra
Phone Nos. / Fax
E-mail Address
M: 9222177561
Off : 07104236201
M: 09822470808
nkpsims1@rediffmail.com
dranjaliedbor@gmail.com
Off : 022psmltmmc@rediffmail.com
24038983,
drpallavis@gmail.com
24063123
M : 9867003734
Fax: 022-24038983
Off : 02224107074
M : 9820097514
Fax: 022-24166006
sanjayoak@kem.edu
expertratnesh@yahoo.com
psmgsmc@kem.edu
Off : 022kulkarniteacher@hotmail.co
24107484
m
M : 9819960961
Fax: 022-24142503
Off : 022slpayu@gmail.com
24038983,
shpays@yahoo.com
24063123
M : 9699740416
Fax: 022-24038983
Off : 020staterchqa.cell@gmail.com
26128000
drrameshbhosale@yahoo.co
Res : 020m
26133367
Fax: 020-26126868
M: 9823037565
State Health Systems Off : 020staterchqa.cell@gmail.com
Resource Centre, 1st
26615505
shsrc.gan@gmail.com
Floor, Arogyabhavan, Res : 020Parivartan Building,
25386821
Alandi Road,
Fax: 020-26615505
Yerawada, PuneM: 9890394334
411036, Maharashtra
KEM Hospital &
Off : 020staterchqa.cell@gmail.com
Research Centre,
26135091
dphalgune@gmail.com
Sardar Moodliar
Res : 020kemunr@vsnl.net
Road, Rasta Peth,
25440197
Pune-411011,
Fax: 020-26125603
Maharashtra
M: 9850434220
18
S.
Name & Designation
No.
29. Dr. A.P. Kulkarni
(BSc, MBBS, DPH,
MD, Ph.D)
Sr. Consultant
Department
Public
health
SHSRC,
Pune411006
30. Dr. Jitendra K.
Deshmukh
(M.D., DGO, DFP,
DICOG, FCTS, DNB)
Asso. Professor
31. Dr. Chinmay Pataki
(M.D. Obst. & Gynae.)
Asst. Professor
Obst. &
Gynae.
32. Dr. (Mrs) Sushma Malik
(M.D. Pediatrics)
Prof. Incharge NICU
Pediatrics
33. Dr. Arun Humne
M.D.( PSM) D.P.H.
PSM
34. Dr. Prakash Adhav
(PGD, M.D., DIH)
Professor & HOD
PSM
West Bengal
35. Dr. Bidyut Kumar Basu
(MBBS, M.D.)
Professor
Obst. &
Gynae.
Obst. &
Gynae.
36. Dr. Gautam
Mukhopadhyay
(M.D. DGO) DNB
Asso. Professor
Obst. &
Gynae.
37. Dr. (Mrs.) Sohini
Bhattacharya
(M.D.)
Obst. &
Gynae.
Office Address
Phone Nos. / Fax
E-mail Address
State Health Systems
Resource Centre, 1st
Floor, Arogyabhavan,
Parivartan Building,
Alandi Road,
Yerawada, Pune411036, Maharashtra
Govt. Medical
College, Nagpur440010, Maharashtra
Off : 020staterchqa.cell@gmail.com
26612010
, drapkulkarni@gmail.com
Fax: 020-26610180
M: 9422701650
Lokmanya Tilak
Municipal Medical
College, Deptt. of
PSM, Dr. B.A. Road,
Sion, Mumbai (Urban
Health Centre,
Dharavi) Mumbai400022, Maharashtra
Deptt. of Pediatrics,
1st Floor, College
Building, TN Medical
College & BYL Nair
Hospital, Mumbai400008, Maharashtra
Govt. Medical
College Nagpur, Near
Hanuman Nagar,
Nagpur-440003,
Maharashtra
Off: 0222-4063152
M: 9769134005
drchinmay@gmail.com
Off : 02223027000
Extn. 7139
Fax: 022-23072663
M: 9819065322
sushmamalik@hotmail.co
m
sushmamalik@gmail.com
Calcutta National
Medical College
(CNMC), 32,
Gorachand Road,
Park Circus, Kolkara700014, West Bengal
N.B. Medical
College, P.O Sushruta
Nagar-734012,
Siliguri, Dist.
Darjeeling, West
Bengal
N.B. Medical
College, P.O Sushruta
Nagar-734012,
Siliguri, Dist.
Darjeeling, W.B.
Off : 03322897122,
Res: 0712-2545296 drjkdeshmukh@gmail.com
Fax: 0712-2750145
vtalloo@rediffmail.com
M: 9822200820
9422164768
Off : 0712drarun_humne@yahoo.co.i
2701369
n
Res : 07122701711
Fax: 0712-2701369
M: 9422102844
9921251441
B.J. Medical College, Off : 020drpsadhav@yahoo.com
Pune Station Road,
25897563
drpsadhav@gmail.com
Pune-411001,
M: 9371010297
Maharashtra
19
cnmcalumni.a@gmail.com
drbdyutibasu@rediffmail.co
m
basu.drbdyuti@gmail.com
2897123
Res: 0332-3374098
M: 09433847695
Off: 0353-2585478
nbmc_slg@yahoo.com
M: 09434377088 gautam_in_66@yahoo.co.uk
09434377088
Off: 0353-2585478
nbmc_slg@yahoo.com
M: 9832072309
drsohinibhattacharya@yaho
o.co.in
Annexure-II
CD Contents
1.
Presentations
2.
Group photograph
3.
Guidelines






















NFHS-3
IPHS SC, PHC, CHC (Downloaded October 2007)
Rogi Kalyan Samiti
Standards for Male & Female sterilization
Training of Trainers on Capacity Building of MC Faculty in RCHIINRHM Strategies
Four Years of NRHM 2005-2009
Adolescent Health and Development (AHD) NPIP RCH Phase II[1]
District Health Action (Downloaded October 2007)
Manual for Family Planning Insurance Scheme (January 2008)
FRU Guidelines 2004
Guidelines for AWWs, ASHAs, ANMs, PRIs - VHND
Guidelines for Operationalizing a Primary Health Centre for Providing 24Hour Delivery and Newborn Care Under RCH-II
Guidelines for Setting up Blood Storage at FRU (October 2007)
IUCD Reference Manual for MO
NRHM-Frame Work for Implementation
NGO guidelines
NRHM Mission Document (October 2007)
NRHM Evaluation Report
Quality Assurance Manual for Sterilization services
SOP Book (FP)
National Training Strategy
IMEP guidelines
20
Annexure-III
Documents Distributed
1.
Reference Manual for Minilap Tubectomy
2.
Monthly
Village
Health
Nutrition
Day
(Guidelines
for
AWWs/ASHAs/ANMs/PRIs
3.
Capacity Building of Medical College Faculty in RCH-II/NRHM (Background
Document Vol. I National Rural Health Mission)
4.
Capacity Building of Medical College Faculty in RCH-II/NRHM (Background
Document Vol. II Reproductive and Child Health)
5.
Capacity Building of Medical College Faculty in RCH-II/NRHM (Background
Document Vol. III National Health Programme)
6.
Manual For Family Planning Insurance Scheme
21
Annexure-IV
Expectation of Participants from the Course
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
Skills & promotion
Laparoscopy, Sterilization, NSV Training
We will get guidelines & teachings to improve teaching to our students in rural areas. To
know role of medical colleges.
Gain knowledge and skills of the NRHM/RCH for the activities that we perform to improve
the quality of training under RCH-II that in turn will improve services at primary &
secondary levels of health care.
To improve health care delivery system and it should reach at bottom level with quality.
I want to go back with a direction in the form of an action plan with a continued link with
the NIHFW, have a life long relationship with NIHFW.
We will get guidelines and teachings from here to teach our students (budding doctors) to
serve better in rural areas.
I expect that the workshop will deal with the NRHM goal and activities in some detail &
subsequently focus on how the quality of services in the health sector can be improved.
To understand medical teachers role in teaching NRHM to medical students and patients
care in teaching hospital.
To brainstorm on causes of failure and ways to arrange for all those things needed to
provide ideal care of education to patients/students.
What will be the role of our medical college in adapting NRHM
Enabling to improve the quality of teaching and health- management at medical college &
state level and also general guidelines.
I expect to know in depth different facts of NRHM and acquire skill to deliver quality
services under NRHM and also to train my colleagues and junior in this aspect.
Adequate knowledge regarding how to improve quality services at their medical colleges
respectively.
How best the medical college faculty be used for effective implementation of NRHM/RCH?
To orient ourselves (medical faculty) about ensuring quality health services to the
community & percolate it to our students.
To gain information regarding newer policies of govt. for NRHM & RCH programme and
implementation of these programmes through private medical college.
- To learn feasible, practical affordable interventions to achieve quality health services to
all stake holders.
- How to introduce in medical education curriculum teach & evaluation?
Developing skills to practice and teach (guide) quality care while delivering health care for
families.
The course should give practical insights in developing “checklists” for monitoring &
“indicators” for evaluation of quality of services under NRHM/RCH & generate mechanism
for linking medical colleges’ expertise with state health services.
To know the key strategies of NRHM, critical quality health issues and mechanism to
incorporate quality in health care services.
To enhance the knowledge and skill on NRHM, so as to improve the health care delivery
system in rural health.
22
23.
24.
25.
26.
27.
28.
29.
30.
31.
32.
33.
34.
To provide quality services to patients at minimum cost so that we are able to increase our
IPD and patients goes fully satisfied and sends other patients in multiplication.
We will be trained in quality services so that we will train lower cadres (DHD, ADHO,
Medical officer, paramedical etc.) appropriately.
How to execute services under NRHM in proper way at all levels of health system.
My main expectation of this workshop/course is to enable to know and give better services
in health both at hospital and community level.
As an incharge of rural health centre in a tribal village under medical college, I expect to
learn innovative ways of launching existing health services under NRHM to deliver the
quality.
Knowing ways and means of improvement of quality of health care.
How we can further improve quality of services given at government hospital
To get practicable, applicable, affordable and cost effective and definitely suitable
knowledge for 75% of Indian population for improvement of economic and social
upliftment there by helping all of us.
Improvement of the quality of obstetric care. To reduce the maternal mortality and
morbidity keeping in mind the limited resources available at the medical institute.
Quality indicators of NRHM/RCH
To acquire in-depth understanding of NRHM and ways of quality induction in it.
̵ To help me in improving quality of health care at peripheral level.
Funding for logistic & to prepare more human resources (capacity building) to
maintain/establish quality services under NRHM.
23
Annexure-V
Participant’s Perception about Quality Services under NRHM by Group-I are
as follows:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
Quality is all good constitutions of a thing which can bring good results.
Quality is giving best out of available resources
Satisfaction and something which should be achieved the community.
A patient when comes to doctors at any level of care is 100% sure that it is the best which is
given to him and the same is true regarding the doctor. Both are 100% sure and confident in
the treatment.
Quality improvement remains a constant process.
Quality is maximum output with minimum input.
Quality in health care is to provide standard of care to all equally as we have proposed to
give.
Quality is cream, essence or best part of something.
Quality is achieving the objective with patient/people satisfaction and convenience and
needs being the top most priority, services being updated with time.
The final result of anything and everything in a practicable suitable manner presented
beautifully and easily understandable and presentable.
Quality is “How much percentage of expected out of it”.
Quality is not measurable but which give satisfaction to customer.
Quality strict adherence to standards of procedure (protocol).
Satisfaction to service provider as well as consumer.
Quality may be a set of objectively defined benchmarks for ensuring that a product/service
is of good standards to benefit the end user and certainly not harm him/her, while also being
perceived as of good standards by the end user.
Quality means to me the most effective way delivering a service which gives maximum
output which minimum input.
Perfection or excellence
Participant’s Perceptions by Group-II are as follows:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
Quality means a well accepted protocol strict adherence to it.
Quality means optimal effective beauty of the event/parameter.
Quality refers the content.
Quality it is a relative term evaluated against attain in? /parameter.
Pre-decided criteria at affordable price.
Quality services can be defined as a “ services in which is scientifically proved to be result
oriented with least advertising”
Quality is that component in any service or activity which makes both recipient and
provider satisfied and outcome is as per the expectations.
Quality the level best in any field
IPHS Indian public health standards
Quality- mark of efficiency, mark of perfection, mark of assurance and a scientific gradation
A tool to measure input and output.
24
12.
13.
14.
15.
16.
17.
18.
The concept and proactive diagnosis and management of diseases has to be changed as per
new concepts and methods of diagnosis under NRHM that is the quality of health
management.
Quality is appropriateness of content and way of delivery leading to best possible outcome.
Quality with reference to health care Assessment of performance of an activity /program on
the backdrop of expectations.
Effective services given to needy people that is very helpful to them.
Quality is: - Planning, implementation, coordination of an activity with accuracy, diligence,
consistency, with optimal use of resources, and ensures that the desired objectives are
achieved.
Quality means scientifically sound technology used in a way that satisfies the user as well as
gives good outcome at right time, for the right person, at reasonable cost.
Quality of care? Role of the medical colleges in improving quality care in areas line family
planning maternal and child health areas.
25
Annexure-VI
Critical issues in quality of Health & F.W. services
GROUP – II
MATERNAL HEALTH & FAMILY WELFAE
Group Representative: - Dr. Chinmaya Pataki
PROBLEMS
PROVIDER
SYSTEM
BENEFICIARY
MATERNAL
PROBLEM
1. Anaemia
 Ignorance
 Take for granted
2. Bleeding in 1st
trim
 No counselling
 Lack of
expertise/knowledge
3. ANC &
Immunisation
4. High Risk
pregnancies
PIH/APH
5. Delivery
 Lack of motivation
 Financial incentives
 Blood transfusion
practices
 Lack of resources
 Lack of
protocol(implementation)
 Quality of iron preparation
 Lack of diagnostic facilities
 OTC Drugs available for
termination of 1st trimester
Pregnancy







Non compliance
Ignorance
Illiteracy
Non compliance
Ignorance
Illiteracy
Gender
discrimination
 Lack of protocol
 Referral and transportation
facilities for patients and
Health provider.
 Janani Suraksha yojna
26
 Reluctance
 Institutional
services
6. Post partum
and lactational
7. Family
planning
unregulated
pregnancy
8. Sociocultural
and gender
issues.
9. Capacity
Building
deliveries not
100%

 Lack of follow up protocol
 Lack of
counselling/motinati
on
 Tubectomy more
popular than
vasectomy.
 Maternal death audit
 Management of near
“miss”
 Lack of protocol
implementation
 Unmet need of
contraception
ignorance.
 EmOC
 BEmOC
GROUP - III
CRITICAL ISSUES OF HEALTH SYSTEM
Group Representative: - Dr. Payal Laad
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
Non uniformity of the Health Services.
Existence of the mixed pattern across the country.
Inadequate budgetary provision in both – allocation and utilization.
Development is not Health Centric.
Non regulation of private sector.
Lack of political will.
Skewed doctor to patient ratio.
Lack of emphasis on health impact of industrialization and urbanization.
Lack of baseline health census.
Lack of data management.
Ill equipped community based health insurance.
Ill focused role of media.
Non existence of co-ordination between medical colleges and public health.
Frequent change of man power.
Bureaucratic red tapism over technical heads of health programmes and medical education.
Management training.
27
Annexure- VII
Experience Sharing
1. DR. ARUN HUMNE
Professor & Head, Community Medicine, Govt. Medical College, Nagpur-440003,
Maharashtra
The experience sharing is related to evaluation of mother NGOs and field NGOs under NRHM,
funded by State Health Systems Resource Centre, Pune.
Expected investigators for this evaluation were medical social workers/interns. We utilized services
of post graduate students of community medicine, who did qualitative analysis alongwith structured
evaluation as per predesigned proforma.
The last unit to be evaluated by us was the village of FNGO, where we arranged meeting of project
coordinators of MNGO and FNGOs, ANM, AWW and PRI office bearers and local leaders.
The scenario prior to this meeting was that ‘There was lack of co-ordination between these agents
of health care delivery system.
With this joint meeting the whole village came to know all details of MNGO & FNGO scheme,
their job responsibilities. All the stake holders at periphery accepted that there would be profound
effect, of course beneficial to achieve the objectives of the MGNO scheme.
The baseline data about the beneficiaries is with us and our team of investigators is prepared to
perform the evaluation after 6 months, in those villages without asking for additional funds from
the sponsors. The PGs have donated the remuneration they received for the present evaluation, so
the same could be used for transportation during next voluntary evaluation planned after six
months.
This has been done for 3 districts. If this model of joint venture and coordinated efforts of health
personnel, FNGOs & PRIs works to improve the quality of health care, the same can be replicated
at other places.
Post graduates are thinking of using the money saved (remuneration after expenditure on voluntary
evaluation) for improvising the PG seminar rooms.
2. Dr. R.R. Shinde
Professor & Head Department of PSM, G.S. Medical College & KEM Hospital, Parel,
Mumbai – 400012
Project title
:
Establishing Integrated Disease Surveillance Programme in the hospital
involving clinical departments coordinated by PSM department.
Task
:
Mainstreaming IDSP in the hospital
28
Introduction: IDSP is one of the flagship programme of Government of India, promoting quality
data management in disease surveillance. The focus is ensuring uniformity, standardization,
reliability, accuracy, consistency & diligency in disease data collection, compilation, analysis and
public health applications.
Clinical specialists are rarely proactive about preparing periodic morbidity / mortality reports and
generally dissociate themselves from this activity citing their main focus on technical case
management. Further, PSM department was viewed as non-clinical department and the clinical
specialist were inclined to place the entire responsibility on PSM Department and evade ownership
of the programme. The existing situation in the hospital indicated that the “Institutional” nature of
“IDSP” would be grossly overlooked and then, there was a possibility of the programme being
reduced to an “activity” of a department (PSM).
Hence, a strategic plan of action was necessary to meet this challenge effectively. This strategic
plan is being presented as “Good Practice” strategy.
Situation Prior to Establishment of IDSP
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
Conventional case papers, indoor papers, report formats
No emphasis on quality of generating case records
No supervision or cross-check of case record contents
Confirmed diagnosis often not mentioned clearly on indoor case papers.
Case-history, treatment, procedures, recorded inadequately.
Case definition and treatment protocols now followed uniformly in all medical units.
No accountability of record maintenance.
Medical Records Department Staff not trained regarding accuracy in recording patient data
(very often address written inadequately)
Clinicians / resident doctors were very reluctant & termed the progress as “clerical job”
The staff nurses, matron, residents viewed it as additional burden.
Laboratory staff expressed displeasure of writing “more” on paper.
No mandate for submission of records or reports on a daily basis.
Medical Supdt / AMO on call not involved in disease report preparation.
No coordinating committee for disease surveillance reporting.
Collaboration with public health department for follow-up surveillance action not
formalized.
Resident Medical Officers not sensitized regarding IDSP.
In view of the above circumstances, the Strategic Approach adopted as follows:1.
2.
3.
4.
5.
Promote the program as “Institutional” rather than PSM Department programme proactively.
Team approach essential, so a coordination committee formed involving PSM, Medicine,
Paediatrics, Microbiology & Medical Records Department with Principal as Chairperson &
PSM as member secretary.
The action plan for coordination was outlined.
The “curative”, “preventive” components of surveillance were identified & departmental
responsibilities were outlined, identified & departmental responsibilities were outlined and
linkage with public health department was outlined.
The Dean & Director was updated & emphasized about the “Institutional mandate” &
meeting of concerned department convened in presence of Dean.
29
6.
7.
8.
9.
10.
11.
12.
13.
14.
The micro plan was explained and an IDSP unit was located in hospital near the casualty
area. It was proposed that this IDSP unit will be converted into Disaster Management
Control room, during disasters.
The registration counter & emergency services were identified & geared for involvement in
IDSP.
Meeting of faculty staff of concerned department held.
The above meeting lead to preparation of a case-definition & treatment protocol manual for
clinicians.
All RMOs were oriented in IDSP and their role in reporting. The need for clearly writing
the confirmed diagnosis on indoor paper was stressed.
The Medical Records department staff was sensitized on the need for accuracy in recording
data.
Additional equipment for rapid blood investigations was installed.
Separate proformas for compiled reporting were devised to facilitate easy record of IDSP
cases in the words (to used by clinical residents) and also for coordinating weekly &
monthly compilation of reports (to be used by PSM Department)
Meeting convened with Executive Health Officer, public health department, to outline
responsibilities of Insecticidal officer, MOH I/c of wards, to work with PSM Department for
surveillance actions.
Core function of IDSP in the hospital:1.
2.
3.
4.
Identify – confirmed disease cases and document the same (clinicians)
Epidemiological investigations of cases & deaths and prepare spot map off cases (PSM
Department)
Implement surveillance actions in the community from where the cases have been located in
the spot map along with public health department.
Reporting on daily basis; timely, accurate, diligent.
Strategic Interventions for Implementation
1.
2.
3.
4.
5.
6.
A stamp of enlisted IDSP cases was prepared and all emergency case papers were stamped
with it.
If a patient reports to emergency services the RMO on duty examines & decides whether the
case is an IDSP case or not based on his clinical acumen. It is an IDSP case, he / she will
mark on the IDSP stamp.
The patient then goes to registration counter. If the clerk, finds that case-paper is ticked as
“IDSP” case, he records the case in a separate IDSP register and takes due care to write
details of address of the patient. The patient then gets admitted in the indoor ward; clinical
unit and his record is entered in ward register by the staff nurse.
The RMOs on duty in wards receive all the emergency lab reports of this patient after about
2-3 hours. He is then able to make a confirmed diagnosis. If not, he reports as “probable”
diagnosis.
The compiled report of all such cases is sent in the proforma devised for clinical wards to
the control unit (IDSP). The interns posted assists in the same.
The PSM department RMO, visits registration counter to note all IDSP cases of the day and
also clarifies queries regarding data, with the RMO in the ward on phone.
30
7.
8.
9.
10.
11.
A team of PSM resident, AMO on call, Lecturer on call meet in the evening at 8 p.m. and
again at 6 a.m. next day to update the compiled report of IDSP cases.
The copy of complied report is sent to Deans residence for his information and media
management in the morning at 7.30 a.m.
The Dean sends the approved compiled report in his office at 8.30 a.m.
This report is collected by the control unit through the AMO posted in Deans office
The compiled report is finalized as reporting of “probable’ and “confirmed” cases and faxed
to IDSP Head Quarters for Mumbai City (Kasturba Hospital) which in turn faxes a
combined report of Mumbai city to State IDSP unit.
Preventive component
1.
2.
3.
The cases are recorded on spot map of Mumbai from their address.
A mobile van reports to the given address for initiating surveillance actions. (PSM residents
intern, surveillance workers from public health department).
Deaths of IDSP cases are investigated epidemiologically by PSM residents, to ascertain
courses contributing to death.
USP of IDSP strategy
The faculty of PSM and residents conduct a preventive OPD in KEM Hospital daily. All new
patients & patients on chronic management are first referred to preventive OPD. The preventive
OPD undertakes screening, counseling, health education, treatment of uncomplicated cases. The
Medicine & Paediatrics OPD is on the same floor and hence, where essential, immediate escorted
referral of cases is possible.
This has facilitated cooperation & active participation of clinical faculty in IDSP. At
institutional level, PSM department has assertively introduced role of PSM faculty as “Doctors of
Health” and role of clinical specialists as “Doctors of Disease”. In public health terms, clinicians
are now referred as specialists of secondary & tertiary prevention.
Collateral benefits
1.
2.
3.
4.
5.
6.
7.
PSM department involved by clinical departments in integrated teaching.
AMOs from clinical departments consult PSM faculty to validate research designs of their
dissertation.
Psychiatry department / OBGY department / Paediatric / Medicine department are proactive
in participating in community health camps in rural & urban areas.
AMOs from clinical department are deputed to urban health centres from community
orientation.
Students from foreign universities seeking “observership” training in clinical departments
are essentially sent to PSM department for orientation of community based health program.
PSM faculty is represented in key positions on the committees viz AEFI, Epidemic control
task force of Public health department and committees at the institution viz. patient
education cell, ethics department, staff society, Research Society, Sexual harassment,
redressal committee, Academic Committee and various enquiry committee.
Post of contractual data entry operator sanctioned and provision for expenses made for
IDSP unit. Further, the location for IDSP unit / control unit ensured in developmental plan
of hospital.
31
8.
Team from NICD visited IDSP unit in 2008, reviewed and endorsed IDSP strategy in
hospital PSM department was included for conducting TOTs in IDSP and the model was
discussed at NICD.
3. Dr. Dinesh Bhanderi
Department of Community Medicine, P. S. Medical College, Karamsad
Evaluation of the government health care services Anand District
Objectives of Survey:
To evaluate the government health care services provided to women in reproductive age and
children under three years age in Anand district.
Minimum 40 or more households were surveyed in each cluster.
The survey was continued in each cluster till:
 Total eight children in age group 12-23 months were found
 At least two antenatal mothers in last trimester were found
 At least five postnatal mothers who delivered in last trimester were studied.
Results
Total 1283 families were surveyed.
32
Distribution of children of age less than 3 years according to place of birth
Place of birth
Govt. health
center(SC,
PHC,CHC)
Govt. District
hospital
Private hospital
Total
Children of Age (months)
0-11
12-23
No.(%)
No.(%)
37(19.9)
75(28.5)
52(28.0)
74(28.1)
24-36
No.(%)
28(26.4)
35(33.0)
Total
No.(%)
140(25.2)
161(29.0)
3(1.6)
3(2.8)
16(2.9)
10(3.8)
94(50.5)
104(39.5)
40(37.7)
186
263
106
(100.0)
(100.0)
(100.0)
Maximum number of children (42.9%) were born in private hospital.




238(42.9)
555
(100.0)
Birth weight of 429(77.3%) children was measured.
85(20.3%) were low birth weight i. e. less than 2.5 Kg.
Mamta card was available for 304(54.8%) children.
In case of 78(14.1%) children, though the card was provided, the mother lost it.
33
34
35
•
•
Mamta card was available for 304(54.8%) children.
In case of 78(14.1%) children, though the card was provided, the mother lost it.
Majority (63.5%) of the children were immunized at government health centers i. e. SC, PHC, CHC
or district hospitals
Vaccine
BCG
DPT-1
DPT-2
DPT-3
OPV-1
OPV-2
OPV-3
Measles
Com immu
% Vaccine Coverage
NFHS-3
MICS
Gujarat
97.0
97.3
93.5
89.7
97.0
95.8
93.5
88.2
84.5
86.4
India
Rural
75.1
India
Total
78.2
61.4
50.4
55.3
65.3
65.7
45.2
76.5
54.2
38.6
78.2
58.8
43.5
Vaccine Coverage
Vaccine
DPT
(booster dose)
OPV
(booster dose)
% Coverage
89.6
90.6
36
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
All the 555 children except two were ever breast-fed.
Out of 553 children who were breast fed, 343(62.0%) received it within the first hour of life.
502(90.5%) children of age less than 3 years were registered at Mamta diwas.
However, only 295(53.2%) children were taken to Mamta Diwas Kendra regularly.
64(11.5%) children were never taken to Mamta Diwas Kendra.
Only 125(22.5%) children received Mamta card, and out of that, parents of only 44(7.9%)
children were able to show this card to the survey team.
Out of 42 children having Mamta card & being taken to Mamta Diwas Kendra, the weights
of only 15(35.7%) were plotted on growth chart during the last visit to Mamta Diwas
Kendra.
Parents of 11(73.3%) out of these 15 children were explained regarding the weight of their
child plotted on growth chart during the last visit to Mamta Diwas Kendra
During the last visit to Mamta Diwas Kendra, parents of 396(80.7%) children were given
advice regarding their feeding.
Majority(63.8%) of the children were found to be registered at Anganwadi
313(76.9%) children of age nine months or more had received vitamin A around Diwali
time.
Out of these 313 children, vitamin A supplementation was recorded in Mamta card of only
107 children.
Out of the 102 pregnant women, 87(85.3%) were registered at Mamta Diwas & 77(75.5%)
had Mamta card.
Weight of 83(95.4%) pregnant women was measured during their last visit to Mamta Divas
Center, out of which, in 57(65.5%) women, it was found to be noted in Mamta card.
Blood pressure of 71(81.6%) women was measured during the last antenatal check up.
88(86.3%) pregnant women were immunized against Tetanus. It was recorded in Mamta
card of 74(72.5%) women.
Though 77(75.5%) pregnant women received Iron tablets, these tablets were actually seen
only in case of 34(33.3%) women.
61(79.2%) out of 77 pregnant women were swallowing these tablets daily
Distribution of pregnant women of age15-45 years according to their knowledge of
Chiranjivee Yojna
Knowledge of Chiranjivee Yojna
Complete knowledge
Incomplete knowledge
No knowledge
Total
Women No. (%)
1(1.0)
11(10.9)
89(88.1)
101(100.0)
Distribution of pregnant women of age15-45 years according to their knowledge of
Janani Suraksha Yojna
Knowledge of Janani Suraksha Yojna
Complete knowledge
Incomplete knowledge
No knowledge
Total
Women No. (%)
1(1.0)
9(8.9)
91(90.1)
101(100.0)
37
Institutional delivery rate was 80.5%
Place of delivery
Home
Govt. health center
District Govt. hospital
Private hospital
Total
Women No. (%)
37(19.5)
52(27.4)
4(2.1)
97(51.0)
190(100.0)
LSCS rate was 15.3%
•
•
•
Out of 64 eligible women, only 6(9.4%) women got the benefit of Chiranjeevi Yojna
Out of 123 eligible women, only 25(20.3%) women got the benefit of JSY
Duration of hospital stay was comparatively longer in women who delivered normally in
private hospital (p<0.01).
Distribution of postnatal women (during last one year) of age15-45 years according to
the postpartum visits
Postpartum visits
First
Second
Third
Nil
Total
Women No. (%)
79(41.6)
11(5.8)
18(9.5)
82(43.2)
190(100.0)
Distribution of postnatal women (during last one year) of age15-45 years according to
the worker who made the postpartum visits
Worker who made the postpartum visits
Anganwadi worker
ANM/FHW
Both
Total
Women No. (%)
82(75.9)
10(9.3)
16(14.8)
108(100.0)
Comparison of some study results with NFHS 3 data
Variable studied
LBW
Institutional
Delivery
LSCS rate
Breast feeding
started within 1
hour of birth
Vitamin A
supplementation
in last six months
Consumption of
Iodated salt
MICS
2008
Anand District %
20.2
80.5
15.3
62.0
76.9
94.6
Gujarat %
22
54.6(42.2 in
rural area)
27.8(25.3 in rural
area)
17.1
(17.9 in rural
area)
72.1
38
NFHS-III
(2005-2006)
India
Total %
21.5
40.7
Rural %
23
28.9
8.5
24.5
5.6
22.4
25.1
24.5
76.1
70.1
Some observations made during MICS
•
•
•
•
•
•
•
In small & remote villages, the distribution of ‘Mamta card’ is not satisfactory.
Nearly half of mothers and children are not given the card even if they attend the sessions.
Inadequate supply of these cards was one of the reasons for not issuing them to the
beneficiaries.
Visits by FHW & supervisory staff were also very less than desired.
Documentation of the activities performed during Mamta Diwas in Mamta card was found
to be poor, even when they were performed e.g. measurement of Blood Pressure and
Vitamin A supplementation.
A wide gap regarding utilization of health services was found across the different socioeconomic strata of the villages.
Mamta card was not used adequately for educating the women regarding nutrition, warning
signs, self-care & newborn care.
Recommendations
•
•
•
•

•
•
•
IEC activities to create awareness regarding various government programmes and schemes
need to be strengthened so as to maximize their utilization by the beneficiaries.
People should be made aware of the importance of BPL card & its benefit. This is
particularly essential in remote and small villages where BPL families are in higher
proportion.
Quality of antenatal and postnatal care should be monitored and supervised by the medical
officers.
Antenatal care sessions should be made more interactive.
Mamta card should be extensively used for education & counseling of pregnant women &
mothers.
Supervisory staff should ensure that at least one postpartum visit is made with in 24 hours
after birth of the baby by the health worker
Presentation of completely filled Mamta/immunization card of the child may be made
compulsory at the time of school admission so as to ensure 100% vaccine coverage.
Parents of the children will also force the health workers to enter all the given vaccines and
examination findings like weight and feeding advice in the card.
It takes whole village to raise a child.
African proverb
39
Annexure-VIII
Presentation of the Group Work
Group- A
Reproductive Health Services
Dr. Ramesh Bhosale, Dr. Kana Ram Jat, Dr. Gautam Mukhopadhyay, Dr. Anita Banerjee,
Dr. Pratibha Dabas, Dr. R. R. Shinde, Dr. Sudhakar Kokane, Dr. Arun Humne, Dr. Dinesh
Bhandari, Dr. Sushma Malik
Service
Maternal
RTI/STI
Contraception
Outdoor
Indoor
Premarital counseling
Pre-pregnancy counseling & care
ANC
-Counseling & Education
-History & General, systemic,
abdominal, gyn. examination
-High Risk Identification
-Screening Hb, Urine, Rh, Bld.Gr., VDRL,
HIV, HBsAg, Pap
 RTI/STI
 Medical disorders
-Immunization
-Advice & Nutrition
- Aaemia prophylaxis
-Delivery plan
PNC
-Anaemia prophylaxis
-Nutrition
-BF, Baby immunization
-Contraception counseling
Counseling, education, behaviour
modification,
Partner counseling/treatment
Condoms
HIV (ICTC Integration)
Screening – VDRL, HPV, Pap
Diagnosis
Treatment
Prevention, contact tracing
(Easy access,
Confidentiality
Address barriers- socio-cultural, etc.)
Adolescents’ Reproductive Health
Education (jeevan shiksha)
(Not to call “Sex Education”)
Counseling of both partners
Supply of expanded basket of
contraceptives
Abnormal pregnancy
Pregnancy complications
Intranatal care
Normal/abnormal labour
Obstetric emergencies
Postpartum complications
Tertiary care to referrals
40
Surgical treatment
Complications management
Tubal ligation
Laparoscopic Sterilization
Complications management
MTP Complications
Tertiary care to referrals
Infertility
Gynaec. Care
etc.
MTP
NSV
Laparoscopic Sterilization
(Women’s Rights & Empowerment
Choice)
Education
Counseling
Investigations
Diagnosis
Treatment
(Access & Affordability
Involving male partner from beginning
Confidentiality
Address barriers- social, etc.)
Diagnosis, Treatment, Education on
Menstrual disorders, etc
Menopause
 Care
 Cancer screening
Cancer- screening, treatment
 Cervix
 Breast
 Ovarian,Other
Operative management
Endoscopy services
Artificial Reproductive
Technology
Tertiary care to referrals
Blood transfusion
Surgical procedures
General Quality Issues:





Woman centered
Women’s rights/ empowerment
Barrier elimination- family, social,
cultural, financial, etc.
Equity
Stigma, confidentiality
Gender issues







Access
Choice
Patient safety
Promptness
Technical competence
Support- family, social, self help
Attention to nutrition
–
–
Identification of severe cases of anaemia.
Identification of pregnant women who need
hospitalization, with signs of complications
during pregnancy and those needing
emergency care.
Safe abortion / MTP
SPECIFIC QUALITY ISSUES
Maternal Health
–
–
–
–
Early registration of pregnancies.
Registration of all pregnant women.
Lost to follow up ANC women- to be
tracked and provide services to them.
Focused ANC.
–
41
Counseling on:
–
–
–
–
–
–
–
–
Care during pregnancy.
Danger signs during pregnancy.
Birth preparedness.
Importance of nutrition.
Registration for the JSY
Availability of funds under the JSY for
referral transport.
Exclusive Breastfeeding, Weaning and
complementary feeding.
Counseling on ENBC
–
–
–
–
–
–
–
–
–
–
Care of a newborn
Contraception
Importance of institutional delivery and
where to go for delivery (Delivery Planning)
Identification of transport in emergency
Importance of seeking post-natal care
Counseling for better nutrition
Information on RTIs, STIs, HIV and AIDS
Prevention of HIV/AIDS, STIs
Personal hygiene
Dangers of sex selection
CONTRACEPTION
–
–
–
–
Contraception counseling
Information on use of contraceptives.
To give condoms, OCPs and other contraceptive services as per their choice to all eligible
couples.
Compensation for loss of wages resulting from sterilization and insurance scheme for family
planning.
RTI / STI
–
–
–
–
–
Counseling on prevention of RTIs and STIs, including HIV/AIDS, and diagnosis and treatment.
Counseling for perimenopausal and post-menopausal problems
Information on causation, transmission, and prevention of HIV/
AIDS and distribution of condoms for dual protection.
VCTC and PPTCT services
GYNAEC CARE
–
–
–
–
–
–
Education of girls.
Awareness activities for prevention of pre-natal sex selection, illegality of pre-natal sex
selection, and special alert for one daughter families.
Communication on the Prevention of Violence against Women, Domestic Violence Act, 2006.
Age at marriage, especially the importance of rising the age at marriage for girls.
Identification of problems of the old and the destitute.
Special attention to the vulnerable and weaker sections of society.
DATA MANAGEMENT:
– Audit of deaths of women.
Mechanisms For Addressing The Quality Issues
1. Use of protocols
2. Setting quality indicators
3. Monitoring and Evaluation, Audits
42
4. Training HCPs in “Quality services”
5. Start accreditation process
6. Adequate health-man power and expertise
7. ‘Adequate’ Training and re-trainings and feedback
8. Accurate estimate of clients/beneficiaries
9. GIS mapping of maternal morbidities/mortalities
10. Identify causes for home deliveries
11. Seniors / experts to take lead role
12. Use of Media
13. Use of technology- PDA, mobile, computers, telemedicine
14. Involve and train local leaders- social, religious, political
15. Increase people’s awareness- maternal care, RTI etc.
16. Incentives to HCW
17. Good practices- 6 Cs
18. Increase financial allocation, creating special expenditure head
19. Mobilize political will, utilizing part of budget of MPs/MLAs for health facility
20. Integration with ICDS
21. Involve Community Based Organizations viz. microfinance credit for empowerment
22. Organizing camps- specialized, need based, screening oriented, educating
23. Convergence with RTO for directives to transport pregnant women with priority.
24. Linkages with National Rural Employment Guarantee Scheme
25. Promotion of PPP schemes for medical or non-medical issues e.g. transport
26. Contraception
a. Access- anonymous supply
b. Awareness
c. Choice
d. Women empowerment
e. Education of adolescents
f. Postnatal counseling
g. Educating religious leaders
h. Political reorientation towards population policy in context of economy
Role of Medical Colleges In Improving The Service Delivery
1.
2.
3.
4.
5.
6.
Tertiary level care and feedback to health service system
Motivation and training of faculty of all medical colleges and HCPs in “Quality services”
Development of protocols for all levels of health care delivery
Develop referral protocol
Maternal death audit, ‘near-miss’/morbidity medical audit
Undertake research on relevant research question of priority areas e.g. operational,
evaluational, etc.
7. Dissertations of PGs focused on national health with special reference to rural area
8. Monitoring/supportive supervision and evaluation through feasible mechanisms.
9. Updating UG & PG syllabi, incorporating evidence based technical strategies of
RCH/NRHM concepts and implementation framework
10. Ongoing inclusion of emerging programmatic interventions in teaching e.g. PNDTA/sex
selection, gender issues, male participation, etc.
11. Integrated teaching of UG/PG students within college and with program managers
12. Examinations to include questions relevant to NRHM/RCH
13. Training activities- TOT, various HCPs at district/state/national levels
14. CMEs
15. Participation in policy making process / planning
43
16. Develop partnership with state/district health/FW authorities to strengthen training and
improve quality services.
17. Participating in developing PIP micro-planning at district/state level
18. Linkages with social groups, NGOs
19. Public education through media etc.
20. Liaison between medical education and public health (MoU)
21. Telemedicine resource center
22. To form advocacy consortium for administrative and technical reforms.
23. Collaborate with FOGSI, IAP, IAPSM
Together We Succeed To Achieve Goal of India’s Health NRHM
44
Group B
Child Health Services Including Newborn Care Preventive &
Curative Services
Dr. Geetanjali Jindal, Dr. Geetika Dheer, Dr. Jitendra Deshmukh, Dr. Mohan K.D, Dr. M.S Pawar,
Dr. Nitin Raithatha, Dr. Navneet, Dr. R. N. Kulkarni, Dr. Sohini Bhattacharya
Objectives




Enumeration of the outdoor & inpatient services
Relevant quality issues
Mechanism for addressing these issues
Improvement of health care delivery at all levels
Outdoor services






General pediatric OPD
Well baby clinic
High risk neonatal clinic
Growth & development assessment
Breast feeding counseling
Adolescent services






Immunization
Nutritional
assessment
counseling
Genetic counseling
Rehabilitation services
Special clinics
Side lab services





PICU
Pediatric ward
Pediatric emergency services
Isolation services
Side lab facilities
Indoor services





Neonatal resuscitation
NICU
Nursery
KMC
Post natal ward
Quality issues….
How do we address them?


Adequate manpower at all levels
Medical, paramedical, supportive service staff
45
and







Appropriate qualifications
Induction training
Inservice training
CME
Approximately 10% of newborns require
some assistance to begin breathing at birth.
About 1% require extensive resuscitative
measures
Neonatal resuscitation
All concerned with newborn care! Not only
pediatricians
 Pediatric advanced life support
 For pediatricians, emergency physicians, family physicians, physician assistants,
nurses, nurse practitioners, paramedics, and other healthcare providers who initiate and
direct advanced life support in pediatric emergencies.
Motivation, sense of responsibility, accountability, communication skills and human touch
Quality issues…
 Physical Infrastructure
 As per the standards
 Basic amenities
 As per the site standards
Patient friendly atmosphere
46
Role models
Quality issues…
 Adequate biomedical equipment and instruments and consumables (drugs,
disposables etc.) of good quality




Purchase
Maintenance(AMC/CMC)
Sensitization and knowledge regarding proper utilization of funds
Training of the staff regarding proper handling,usage and maintenance of
equipment
 Back up of Biomedical engineer
Funding




Adequate funds from the concerned administration
Sensitization regarding proper utilization of funds
Proper biomedical waste disposal at all levels as per standard guidelines
Reinforcement of infection control practices
Quality issues….
 Ensuring good quality services
 Strict adherence to standard protocols by concerned health care providers
 Periodic check of quality of services provided
 Supervision by senior faculty
 Review meetings /audit
 Exit interviews of beneficiaries
Record keeping
 Accurate
and
complete
documentation and record keeping





47
ICD -10 coding
Medical certification of death
Daily ward notes
Data entry personnel
Periodic statistical meetings
Quality issues…
 Ensure follow up
 Counselling
 Follow up cards
 Tracking of the lost to follow up patients (correspondence via letter, phone, home visit)
Quality issues…
 Health education
 Counselling
 Audio-visual aids
 Use of mass media
Quality issues…
 Optimizing patient turn around time
 Adequate manpower
 Adequate equipment
 Sensitization of staff
 Patient feedback
 Regular monitoring of the turn around time
Referral
 Sensitization of the peripheral health organizations regarding the importance of a good
referral
 What
 when
 Where
 Appropriate feedback to the referring authorities
Citizen charter
 Proper exhibit of the existing facilities available at appropriate places
Mobile units to carry sick patients to the hospitals
 Mobile health unit to visit underprivileged and marginalized pediatric population
 Foster homes/orphanages
Role of medical colleges in improvement of health care delivery at all levels







Inservice training of the medical and paramedical staff from village levels to district levels
Identifications of the various units to establish such linkages
Monitoring of the impact of training at these peripheral health units
Linkages to district hospitals for higher level of care via improved referral services
Telemedicine facilities connecting to district and village level
Research with orientation to rural areas
Mobile health unit to visit underprivileged and marginalized pediatric population
 Foster homes/orphanages
48
Group C
Communicable And Non-Communicable Diseases (Preventive And
Curative Services)
Dr.A.P.Kulkarni- Chairman, Dr.Pallavi Shelke- Presenter, Dr.P.S. Adhav, Dr. Ashok Salwan, Dr.
Pankaj Patil, Dr.S.Deshpande, Dr. Omprakash Shukla, Dr.S.Choudhary
Outdoor services (OPD)
10. Store –general
11. Record section
12. Nursing station
13. Ambulatory service-interdepartmental
14. Minor OT
15. Physiotherapy
16. Immunization and ORT corner
17. Ambulance
18. FP & BCC
1.
2.
3.
4.
Help desk
Registration
Waiting
Examination-dept OPDs, -speciality OPD
5. Investigations (lab, imaging)
6. Education and counselling
7. Pharmacy
8. Notification
9. Billing
Outdoor services (OPD)-other




Casualty (with MLC section)
Blood bank
PRO
Post-mortem and mortuary services
Indoor services
1.
2.
3.
4.
5.
Registration
Wards
Pharmacy
Non-medical store
Operation theatres
Anaesthesia service
7. Record section
8. Follow up service
9. ICUs and ICCU
Supportive services
1.
2.
3.
4.
5.
6.
7.
8.
9.
House keeping
Waste management
Kitchen
Sterilization unit
Laundry
Water supply
Cold chain facility
Utility services e.g. telephone, bank
Relatives accommodation (Dharmashala )
10. Security
11. Telephone(EPABX) service
12. Computer section (HMIS, IDSP)
13. Administrative –ministerial staff e.g.
accounts
14. Public address system
15. Out-reach activities
16. RKS and others
17. MSW services
Issues
 MCI norms as per no. of students not work load
 Norms for teaching not for hospital services provided for support staff
 Tertiary care hospitals compelled to primary care services
49




Red tapism
Lack of formal managerial training and Communication skills
Lack of SOPs and protocol
No updating and timely information regarding changing guidelines of health care
Tools for quality monitoring and evaluation












MCI and nursing council norms
Accreditation norms e.g. NABH, NABL
TISS norms? Not yet accepted by GOI
Quality assurance committee
Grievance redressal committee
RTI
Internal, external audit- financial,
performance
 MET cell, CME points
 Ethical and research committee(Inst
Research and Review board)





Periodic reports and interim assessment
Death audit
Performance budget
Citizen charter
Various committees- HICC, purchase
committee
Staff grievances redressal
Outsourcing
G-OPD
Operational research
Using existing norms and standards e.g.
ISO, Blood bank, FDA norms
Linkage mechanisms









Liaison officer
Inclusion of public health specialists in services provided by medical college
Inclusion of medical college specialists in services provided by public health personnel
referral feedback mechanism e.g. IMNCI, DOTS, ASHA
Training and updating of para-medicals, medical officer and other public health officials
Public-private partnership
Collaborating with PRI at peripheral level
Liaison with HFWTC
RCH mela, out-reach camps e.g. prevention of blindness, cancer detection
50
GROUP - D
Supervisory Check List For Quality Services During VHND
Dr. Deepak Phalgune, Dr. Vijay Kamale, Dr. Seema Anjenaya, Dr. K. R. Shah, Dr. Bidyut
Kumar Basu, Dr. Moneet Walia, Dr. Anjali Edbor, Dr. Chinmaya Pataki, Dr. Payal Laad
Village Health Nutrition Day (VHND)
Once a month
Hub of services in RCH II, NRHM
Inter-sectoral convergence
Platform for interfacing between community & the health system
Roles of ASHA, AWW , ANM well redefined
Outcomes should be measured and monitored
INTRODUCTORY INFORMATION
Name of the Village
Name of the Sub centre
Name of the PHC
Date of visit
Name of the Block
Name of the District
Name of the State
INFORMATION ABOUT ASHA
Name of the ASHA
Qualification
Years / Months of service
Training received - Y/N
Disbursement of incentives for mobilizing clients - Y/N
INFORMATION OF AWW
Name of the AWW
Qualification
Years / months of service
Training received - Y/N,
If yes, Induction / IMNCI/any other
Remuneration amount whether received regularly - Y/N
INFORMATION OF ANM
Name of the ANM
Years / months in service
Training received
If Yes (SAB / IMNCI any other ) - Y/N
Married - Y/N
From Govt. Setup / Contractual
VITAL INFORMATION
No of deaths in last month
– 0-2 months
– 2m – 5yrs
No. of marriages
No. of child marriages
No. of new births
51
– Maternal
Causes of the death
MATERNAL HEALTH
No. of families SC/ST
No. of families of SC/ST ASHA visited
No. of pregnant women registered ( List)
No. of women registered before 12 wks of pregnancy (list)
No. of women having high risk pregnancy (list)
No. of pregnant women having two living children (list)
No. of high risk pregnancy women referred to PHC for check up
MATERNAL HEALTH…
No. of mother beneficiaries of JSY and amount given
No. of pregnant women checked for
– Blood pressure
– Hb
– Urine examination
No. of women received TT - one dose & two doses
No. of women received IFA and how many
MATERNAL HEALTH…
No. of pregnant women received counseling for
– Care during pregnancy.
– Post-natal care.
– Danger signs during pregnancy.
– Breastfeeding & complementary feeding.
– Birth preparedness.
– Care of a newborn.
– Importance of nutrition.
– Contraception
– Institutional delivery.
Identification of referral transport if needed
Identification of nearest FRU/DH for referral ( Distance from the village)
Availability of funds under JSY for referral transport and the amount given
POST NATAL CARE
No. of visits to the house post delivery and days of visits
No of visits to the house in cases where newborn was underweight and days of visit
FAMILY PLANNING
No. of eligible couples in the village
No. of eligible couples using contraception
– spacing – condoms /OC pills / IUCDs
– permanent methods - Tubectomy / vasectomy
No. of condoms distributed in a month
No. of OCPs distributed in a month
No. of IUCDs inserted in a month
No. of tubectomies and vasectomies performed in a month
52
CHILD HEALTH
No. of LBWs
Counseling for care of newborns and feeding - Y/N
No. of primary immunization given
–
BCG
–
–
OPV-0,1,2,3
–
DPT- 1,2,3
MEASLES & Vit A
Infants up to 1 year:
No. of infants completely immunized
No. of infants regularly weighed
No. of infants reporting AEFI
No. of infants with malnourishment grade III & IV (list)
Children aged 1-3 years:
No. of children who received Booster dose of DPT/OPV.
No. of children who received Second to fifth dose of Vitamin A
No. of children who received Tablet IFA - (small) to children with clinical anaemia.
No. of children who were weighed regularly.
No. of children who received supplementary food for grades of mild malnutrition
No. of children who were referred for severe malnutrition (list).
All children below 5 years:
No. of missed children tracked and vaccinated by ASHA and AWW.
No. of Cases of diarrhea
No. of Cases managed for diarrhea
No. of ORS distributed
No. of Cases of diarrhea referred to PHC / FRU
No. of cases Acute Respiratory Infections.
No. of Cases of ARI referred to PHC / FRU
No. of mothers counseled on home management and where to go in event of complications.
Organizing ORS depots at the session site - Y/N
No. of mothers counseled on worm infestations
RTI & STIs
No. of sessions on counseling on prevention of RTIs and STIs, including HIV/AIDS
No. of cases referred for diagnosis and treatment of the same
No. of women counseled for peri-menopausal & post-menopausal problems
Referral for VCTC and PPTCT services to the appropriate institutions.
SANITATION
No. of households having the sanitary latrines
No. of households identified for the construction of sanitary latrines
No. of households guided on Total Sanitation Campaign
No. of breeding sites identified for mosquitoes
No. of households mobilized for community action for safe disposal of household refuse
and garbage
53
WATER SUPPLY
No. of households having the access to safe water supply
No. of days chlorination of well is performed in a week
COMMUNICABLE DISEASES
No. of group communication sessions held for raising awareness about signs & symptoms
of leprosy, suspected cases, and referrals.
No. of depots for collection of blood film for MP and presumptive treatment.
No. of sessions on awareness generation about TB
No. of symptomatic sent for sputum examination at the nearest health centre
No. of patients provided with DOTS
No. of unusual numbers of cases of any disease or disease outbreak reported in village
GENDER
No. of sessions held for prevention of pre-natal sex selection
No. of sessions held on prevention of violence against Women
No. of sessions held on age at marriage
No of women married before the age of 18yrs
HEALTH PROMOTION
No. of sessions held on :
– Tobacco chewing
– Healthy lifestyle
– Proper diet
–
–
Check list of VHND
No. of women came for the VHND
No. of pregnant women came for the VHND
No. of lactating mothers came for the VHND
No. of women attended having under 5 children
No. of women attended with malnourished children
No. of malnourished children in need of supplementary nutrition
No. of malnourished children availed supplementary nutrition
No. of patients suffering from Tuberculosis
No. of patients came to collect DOTS
Inspection of AW
Cleanliness
Ventilation
Light
Safe drinking water
Place of privacy for ANC
No. of MCH cards
Toys and other things for NFPSE
Charts, posters, photographs
Vaccine supply available - Y/N
– OPV - DPT
- Measles
Storage of vaccine vials – Appropriate – Y/N
54
Proper exercise
Food that can be grown
locally
Cold chain maintained - Y/N
Ice packs available - Y/N
Place of giving vaccination – Satisfactory – Y/N
Inspection of VHND
M.O. present – Y/N
ANM present - Y/N
MPW present - Y/N
School teachers present - Y/N
Sarpanch / PRI member present - Y/N
Village Health and sanitation committee members present - Y/N
SHG present - Y/N
NGO ( If applicable) members present - Y/N
Instruments
Examination table
Bed screen/ Curtain
Weighing machine scale – Adult Child
Checking of weighing machine for
accuracy
Gloves availability
Syringes and needles , disposal of them
Foetoscope
Hb meter
BP instrument
Checking calibration of BP instrument
Stethoscope
Measuring tape
Kit for urine examination
Laboratory consumables, eg. Stain,
Slides
IEC material
Medicines
Vit A
IFA tabs
ORS
Tab Cotrimaxazole
Antihelminthic drugs
DOTS
Tab Paracetamol
Condoms
OCPs (ECPs)
AYUSH
Home remedies for common ailments
Publicity
VHND programme schedule displayed & disseminated - Y/N
Timing of VHND programme
Wall writing on local language
Hoarding present - Y/N
Handbills , pamphlets distributed - Y/N
Client satisfaction
Exit interviews with 5 clients ( 1 pregnant mother, 1 lactating mother, 1 each Adolescent girl
& boy, 1 Post menopausal woman)
Focus Group Discussions
Interviews regarding dates of repeat visits for immunization, birth preparedness and the
institution identified for delivery.
55
Annexure- IX
Suggestions given by Participants to involve Medical Colleges in
NRHM
A. Maharashtra
 Name of Participant
Department
:
:
Dr. R.R. Shinde
Preventive and Social Medicine, Prof. / Head, G.S. Medical
College, Mumbai
1)
Involve faculty of PSM department in training programmes as (TOTs) resource persons at
state and district and national levels.
2) Recognize Rural Health Training Centres affiliated to PSM department – Medical College
as a component of primary health care system and provide funds structural and functional
upgradation. The staff can be utilized for evaluation and research.
3) Medical Colleges located in metro cities (e.g Mumbai) serve as apex institute, catering to
rural populations in the state. Hence, should receive funds, as per provision for a district
hospital in NRHM.
4) Faculty of PSM (Professors) to be involved as members of Quality Assurance Committees
under NRHM.
5) Faculty can undertake monitoring, evaluation and research activities to create evidence for
strategic modifications.
6) Faculty can be involved as planners to assist state/district, to develop PIPs
7) Postgraduate students can be given “dissertation” assignments for M/D. / D.P.H. course
on “NRHM “ issues and the same may be considered for financial support.
8) “NRHM” newsletter can be developed at state level to include updates / progress of
NRHM, involving PSM faculty as Editors / editorial team members.
9) Promote formation of state level public health consortium, affiliated to National Public
Health Consortium, of NIHFW to create advocacy platform for NRHM, thereby average
as stakeholders in policy development.
10) Document the role of medical colleges in NRHM (govt.) circulars, generated at National /
State levels through health secretary / Mission Director. A letter indicating inclination or
directives to the state to involve medical colleges (especially PSM faculty) at all levels for
technical and managerial support in NRHM.
11) Issue directives to universities to include NRHM in Medical syllabus for UG/PG courses
in PSM, Gynaecology and Obstetrics, Pediatrics.
 Name of Participant
Department
1)
2)
3)
4)
5)
6)
:
:
Dr. Mohan Doibale
PSM Department, Govt.
Maharashtra
Medical
College,
Aurangabad,
NRHM – policy making at all levels.
Quality Assurance Committee – state and district level
Training and evaluation at district level
Rural Health Training Centres under PSM department of Medical Colleges should be
treated as FRU/CHC under NRHM and funds should be made available.
PSM department as State Health Training Centre or Regional Training Centers should be
supported under NRHM.
Convergence at district and state level in PIP and DLHAP.
56
 Name of Participant
Department
1)
2)
3)
4)
5)
6)
7)
8)
Dr. A.P. Kulkarni
Sr. Consultant, State Health Systems Resource Centre, Pune
Inclusion of at least one senior faculty of PSM in preparation, monitoring of district PIP
(although recommended, it is not practiced actually)
Inclusion of faculty of Medical College in third party evaluation of programme under
NRHM with monetary incentives.
Sanction of grant in aid to M.D (Thesis) projects as is available under RNTCP
Inclusion of faculty in Medical Colleges in training programmes at HFWTCs, DTTs
Preparing PIPs for Medical Colleges and allotting grants for activities under NRHM.
Allotment of a district to a willing medical college with institute serving as “Guardian” for
NRHM.
Currently the field practice areas of medical colleges are in ‘no-man’s-land’. They should
be given budget from NRHM which will bring accountability and their participation.
Sensitization of Deans on NRHM.
 Name of Participant
Department
1)
2)
3)
:
:
:
:
Dr. D.S. Phalgune
PSM, KEM Hospital Research Centre, Pune
Involvement in various training programmes under RCH II
Formulate strategies to implement, monitor and evaluate NRHM.
Teaching UGs and PGs regarding various aspects of NRHM.
 Name of Participant
Department
:
:
Dr. Sushma Malik
Professor (Paediatrics) Incharge – Neonatology, Nair Hospital,
Mumbai
The Medical Colleges should be involved firstly in the departments of Paed/ Obst./PSM
(a) Preparation and planning of programmes at grassroot level
(b) Preparation of SOP and making of protocols
(c) Should be involved in the training of community health workers
(d) Regular updates of all new things happening in NRHM should be conveyed to medical
colleges, so that the knowledge can be given to all UG & PGs
 Name of Participant
Department
1)
2)
3)
4)
5)
6)
7)
8)
:
:
Dr. R.A. Bhosale
Obstetrics & Gynaecology, B.J. Medical College, Pune Station
Road, Pune-411001, Maharashtra
Medical College Professors may be involved in policy / programme making from drafting
stage.
Medical Colleges can be involved as Resource Centre for Tele-medicine facility.
For training of various sort at district / State / National level, TOTs, CMEs.
Appropriate Technology development and utilization.
Involve in research in priority areas the faculty & large number of post graduate training
& give funding.
Involve universities for updating syllabus.
Arrange conferences / seminars / symposium on Health Programme like NRHM with
Medical colleges and fund it to inculcate in PG/UG students.
Use as Intellectual capital / ‘think tank’.
57
 Name of Participant
Department
1)
2)
3)
4)
5)
Department
2)
3)
4)
5)
6)
7)
Department
5)
6)
Department
2)
3)
College
:
:
Dr. R.N. Kulkarni
PSM, G.S. Medical College, Deptt. of PSM, Parel, Mumbai400012, Maharashtra
:
:
Dr. Adhav Prakash
PSM, B.J. Medical College, Pune Station Road, Pune-411001,
Maharashtra
Training faculty for various cadre.
Model service provider.
Bringing vital contents in the MBBS curriculum.
Allotting the topics related to NRHM to PG Dissertation so that P.G will have in-depth
knowledge in these issues.
Chairman / member of group of committee evaluating the NRHM delivery in remote area.
To provide regular feedback (monthly or quarterly)
 Name of Participant
1)
Medical
Medical Colleges are given valuable inputs to State health department for quality
improvement in program implementations including NRHM via Quality Assurance Cells.
Medical colleges can be involved in pre-service training to various health functionaries.
Medical college faculties can carry out monitoring and evaluation of health programme
run by State health departments.
Medical colleges can admit and treat serious patients referred by peripheral health
facilities running health services.
Medical college can develop Standard of Practices (SOP) or protocols to carry out various
treatment modalities / procedures.
Medical colleges can offer hands on training for family welfare procedures such as lap
sterilization, minilap, NSV etc.
Medical colleges can impart latest treatment modalities / new development in other
aspects of health care delivery.
 Name of Participant
1)
2)
3)
4)
Dr Anita Banerjee
Pediatrics, Indira Gandhi Government
(IGGMC), Nagpur-440012, Maharashtra
Teachers to be involved in decision making.
Training of ANMs and MOs in Medical College (deputation) and organizing workshops,
follow up.
Protocols for management of diseases to be ascertained by the Professors from time to
time.
Protocols for referrals and further management of those patients when they arrive at
tertiary hospital.
Streamlining of services at all levels of health care.
 Name of Participant
1)
:
:
:
:
Dr. Shailesh R. Deshpande
PSM, State Health Systems Resource Centre, Pune
Dialogue between DHS & DMER of the States, facilitated by interventions at higher
level. Subsequently meeting of Dean / Principal / Director may be arranged.
PSM departments, especially their field practice area may be given specific assignments
and necessary budget through NRHM or through other appropriate budget.
Inclusion of NRHM issues in UG & PG curriculum after consultation with MCI,
Universities and DMER.
58
4)
5)
Budget provision to esp. Obst. / Gynae. & Paediatrics departments for purchase of
necessary drugs and equipments.
District / State PIP should include contributions from Medical Colleges & proportionate
budgetary provision.
 Name of Participant
Department
1)
2)
3)
4)
5)
6)
7)
Department
2)
3)
4)
Department
6)
Dr. Payal Laad
Community Medicine (PSM), LTMMC, Sion, Mumbai-22
:
:
Dr. Pallavi S. Shelke
PSM, LTMMC, Sion, Mumbai-22
Involving in preparing PIP.
Protocol preparation.
Involving them at planning, policy making level.
Covering Rural Health Centres attached to Medical Colleges under NRHM.
Communicating adequately and timely the changing strategies, so that it can be taught to
UG & PG students.
Sponsoring relevant research work or model projects.
 Name of Participant
Department
1)
2)
:
:
Rural health training centre can be given the funds under NRHM. This would help
medical college function better. All medical colleges are required to have rural training
centres under their administration, constraint faced is in form of funds to set up
infrastructure.
Research done in rural field practice area should be funded by NRHM, Research and
development committee. The way to obtain fund should be intimated well on website of
NRHM.
The Quality Assurance Committee should be including technocrats from Community
Medicines Dept. of Medical College.
Medical colleges can become facilitator for training or evaluation as a third party under
NRHM.
 Name of Participant
1)
2)
3)
4)
5)
Dr. Chinmay Pataki
Obst. & Gynae, LTMMC, Sion, Mumbai-22
Involved Medical colleges HODs in Policy making.
Revamp all Medical Colleges as it is NRHM’s responsibility also if it expects fault from
Medical Colleges to train the trainee.
Renovate the basis facilities in Medical Colleges
Make the training programmes. Reward based in terms of Infrastructure development.
Stop doing quick fix like 16 weeks training to perform cesarean, rather put faculty on
deputation on monthly basis with good incentives.
Improve Library facilities which are poorer than periphery.
Keep track of obscene amount of money put blindly in health programmes without any
practical change.
 Name of Participant
1)
:
:
:
:
Dr. Madhukar S. Pawar
Principal, HFWTC Nasik
Involve of PSM, Obst. & Paediatric Dept. of medical college in preparation of Dist. PIP.
Involvement concerned departments of MC for preparing training modules of various
trainings under NRHM.
59
3)
4)
5)
6)
7)
8)
Research studies in impact evaluation/process evaluation of NRHM activities in Non
NRHM Vs NRHM area or before and after NRHM.
Involving teachers of concerned dept. of MC as Master trainer /GOI for different
trainings.
To get exposure to recent advances in health care delivery district /divisional level health
authorities to be called as guest lecturer for training undergraduates.
Preparing SOPs, quality standards for different procedures/activities under NRHM.
Doing facility survey with help UGs/PGs
Supportive supervision of activities like IPHS, CHCs PHCs, SC etc.
 Name of Participant
Department
1)
2)
3)
4)
5)
6)
Department
Department
2)
3)
4)
5)
6)
7)
:
:
Dr. Anjali Edbor
Pediatrics, N.K.P. Salve Institute of Medical Sciences & LMH,
Digdon Hills, Hingna Road, Nagpur-440019, Maharashtra
Involvement of Paediatrician at the PHC level.
Interaction of the ANM, AWW & ASHA with Medical Faculty.
Involvement of Private Medical Colleges situated in Rural Area for all concerns.
 Name of Participant
1)
Dr. Arun Humne
PSM, Govt. Medical College Nagpur, Near Hanuman Nagar,
Nagpur-440003, Maharashtra
Sensitization of Directors, medical Education and Research, and the Deans is required.
Professor and heads of Community Medicine can work as Regional Coordinator to
supervise the work of dist. Program managers.
Regular evaluation of various schemes like ASHA, MNGO, JSY can be done by
community Medicine preferably in the month of July/August.
Community medicine, Obst. and Paediatrics can impart training to all the workshop in
NRHM.
Professors and Heads at least Community Medicine should be involved in all National
Health Programs right from planning through implementation. So that the details of the
program can be taught to medical students concurrently as it takes some years to appear
the program in text books.
Professor and Heads, Community Medicine Obst. and paediatrics should be on mailing
list and should be updated with recent advancements in NRHM.
 Name of Participant
1)
2)
3)
:
:
:
:
Dr. Vijay N Kamale
Pediatrics, MGM Medical College, Kamothe, Navi Mumbari,
Distt. Raigad-410209, Maharashtra
Orientation of Dean regarding NRHM Programmes & its importance in patient care
(quality).
Orientation of teaching staff through emails or publication.
Making aware of teaching staff by sending publications to library at reasonable cost.
Displaying on NRHM website about research they wanted for improvement of quality
care at community level.
To train ASHA/Anganwadi worker and make them aware of local accredited hospital as
well as Medical College.
A visit to Anganwadi, sub-centre, PMC & FPV made compulsory for undergraduate
student.
Communication skills & counseling – a practical assessment should be compulsory for
both U.G & P.G students.
60
 Name of Participant
Department
1)
2)
3)
4)
5)
6)
As integrator between health services and NRHM.
Facilitator in Programmes.
Tutor for up-gradation of knowledge.
Monitoring of services
Accreditation of centre.
Feedback centre – on morbidity & mortality.
 Name of Participant
Department
1)
2)
3)
Department
Department
2)
3)
4)
5)
6)
7)
Dr. Seem Anjenaya
Prof. & HOD Dept. of PSM, MGM Medical College, Kamothe,
Navi Mumbari, Distt. Raigad-410209, Maharashtra
:
:
Dr. Pankaj Patil
Obs/Gyne, MGM Medical College, Kamothe, Navi Mumbari,
Distt. Raigad-410209, Maharashtra
Immediate
Involve medical college administration
Provision for LSCS and remuneration
All family planning measures should be applied
Accreditation medical college hospital
 Name of Participant
1)
:
:
The medical colleges should be involved right from the stage of planning, policy and
decision making.
Funds from NRHM should be provided to medical colleges, so that atleast the objectives
of NRHM could be fulfilled in the field practice areas of medical colleges.
Training and retraining of faculties from dept. of PSM OBGY & Paediatrics.
 Name of Participant
1)
2)
3)
4)
5)
: Dr. Jitendra K. Deshmukh
: Obstetrics & Gynaecology, Govt. Medical College, Nagpur440010, Maharashtra
:
:
Dr. Sudhakar Kokane
Public Health Deptt., Govt. of Maharashtra, Principal, Health &
Family Welfare Training Centre, Pune
Involvement of Medical College – Especially Deptt. of PSM Gynae, Obst., Paediatric,
Microbiology to prepare annual PIP for district.
Separate PIP for each medical college or atleast concerned about RCH activities should be
prepared.
Orientation about NRHM of all HOD of medical college alongwith Dean & DMER.
Medical college can be involved for preparation of Training material.
Quarterly meeting of Director of Health Services with Medical Education Director and all
concerned Deans with specialists.
Convergence between ICDS, Medical, Education & Health Services, Social Welfare &
Tribal Deptt. – Monthly Review by Chief Secretary of Govt.
Field visit arrangement to PHC, SC, CHC & District Hospital with medical College
people to give suggestion to improve health delivery system and medical college people
will also be oriented there by health service people.
61
B. Gujarat
 Name of Participant
Department
1)
2)
3)
4)
5)
Department
3)
4)
5)
6)
7)
:
:
Dr. O.P. Shukla
Paediatrics, Medical College Baroda
Allocation of funds to Medical Colleges in N.R.HM.
A good Quality Services Training and Workshop such trained persons be designated as
NRHM Quality Consultants.
Medical Colleges can be involved in training & teachings
(a) EmNC training (Emergency Newborn Training) for Medical Officers – 4 months
course – presently run by some Medical Colleges.
(b) EmNC training for Nurses – 1 month training
Funds are allocated for Trainers / Trainees / One time Infrastructure Grants / Stationary
and contingency. Some of these Grants can be utilized for upgradation of Department
Medical Colleges can be involved in
– Policy making
– Advocacy
– Teaching / Training of MOs / Health Workers
– Evaluation
– Supervision
And funds should be allocated for faculties / trainees plus extra funds for contingencies –
so that this money is used for departmental activities. For all these activities, direct
funding to the department should also go so as to enrich the department.
Proper services / job environment and job satisfaction including good payment vis-à-vis
private Consultants so as to increase the already good motivation of Medical College
teachers and a uniform policy for all Medical Colleges in the State as that of Centre
including Time-bound promotion & pay-commissions.
For every training / teaching – funds should be allocated to Medical Colleges.
 Name of Participant
Department
1)
2)
Dr. Dinesh Bhanderi
Community Medicine, Pramukh Swami Medical College,
Karamsad-388325, District Anand, Gujarat
One faculty from Community Medicine should be a member of District Health Mission.
Community Medicine department should be involved in PIP as well in process of
monitoring and evaluation.
50% of Medical Colleges are private. Their role in NRHM should be clearly defined.
MBBS curriculum must include orientation about NRHM & some practical training.
Faculty may be trained in quality assurance so that they can act as Consultants in that
field.
 Name of Participant
1)
2)
:
:
:
:
Dr. Nitin S. Raithatha
Obst. & Gynae, Pramukh Swami Medical College, Karamsad388325, District Anand, Gujarat
Improvement in Medical education: Content, techniques, assessments (curriculum exam)
Role model for different level services or create one PHC under authority of model unit
for practical demonstration
– Supportive supervision – in house, in field as a third party.
– Operational Research.
– Maintain the SOP for integration for skill practices.
62
–
–
–
Need provision of fund for basic infrastructure, operationalisation and research work.
MCI should take the lead for all above mention suggestion so they can be percolate
down to appropriate authority.
Govt. vs private medical college – to define rights and responsibilities.
 Name of Participant
Department
1)
2)
3)
4)
5)
:
:
Dr. Dipan Patel
Paediatrics, Pramukh Swami Medical College, Karamsad388325, District Anand, Gujarat
Integrate and update the Medical Colleges about the recent activities and objective of
NRHM.
Provision of funds to Medical Colleges to improve infrastructure of college hospitals.
Identification of leader in Medical College to coordinate with NRHM.
Integration of primary health care services with Medical College.
Training of peripheral health worker by faculties of Medical College and their activities to
be supervised
C. Punjab
 Name of Participant
Department
1)
2)
3)
Department
2)
:
:
Dr. Ashok Salwan
Gynae & Obstetric, Govt. Medical College Amritsar-143001,
Punjab
Teaching regarding NRHM should be made compulsory in P.G Course in all specialties
because these students are our future Medical Officers and they will handle the things
better.
Medical Faculties in Medical Colleges should be trained under NRHM, of all specialties
to impart training to the PGs of their specialties.
 Name of Participant
Department
1)
2)
Dr. Moneet Walia
Obs/Gyne., Christian Medical College & Hospital, Ludhiana141008, Punjab
To prepare protocols for various high risk.
To have short term training courses of MO (Medical Officer) in medical college.
To organize rural camps in association with Medical College for various specialties.
 Name of Participant
1)
:
:
:
:
Dr. Pratibha Dabas
Community Medicine, Christian Medical College & Hospital,
Ludhiana-141008, Punjab
Assign a Consultant from Medical Faculty for NRHM.
Coordination with Private Medical Colleges, peripheral health centres and their workers.
63
D. West Bengal
 Name of Participant
Department
1)
2)
Department
2)
3)
4)
5)
6)
7)
8)
Dr. Gautam Mukhopadhyay
Gyneaecology and obstetrics, N.B. Medical College, P.O
Sushruta Nagar-734012, Siliguri, Dist. Darjeeling, West Bengal
Involve faculties in Training, Evaluation and Supportive Supervision.
Provision of some untied funds to Medical Colleges. To make students, nurses aware of
the mission, this when in service they are already updated about the mission.
Communication between peripheral health service people for better service delivery.
 Name of Participant
1)
:
:
:
:
Dr. Bidyut Kumar Basu
Obst. / Gynae, CNMC, 32, Gorachand Road, Park Circus,
Kolkara-700014, West Bengal
Coordination between Medical Colleges and Health Service section of the state is required
first and national level helps for NRHM.
Medical Colleges can put suggestions, work and intellectual input - to any programme in
the state on Medical Science/ and also for National level.
75% of our countries population resides in rural areas, so development of the rural sector
is definitely needed (Health Sector).
NRHM – programme started in 2005 but incorporating Medical College is a late event. At
last it came to Medical college better late than never for betterment of course.
To be incorporated in MCI academic course of MBBS and may be thought in Post
graduation course.
A mandatory event (thing) one year rural service before giving registration by MCI or No.
for doctors. MBBS rigorously to be followed probably MCI is trying.
The teachers of medical colleges joining NRHM project – should have some sort of
directives – either promotion / monetary benefit for encouraging the teachers.
Let the attempt for integration of NRHM with Medical College to continue, let more
teachers come to NRHM (NIHFW) programme here from other Medical Colleges
E. Haryana
 Name of Participant
Department
1)
2)
3)
4)
5)
6)
7)
8)
9)
:
:
Dr. Seema Choudhary
Community Medicine, Maharaja Agrasen Medical College,
Agroha, Hisar-125047, Haryana
The National Health Programmes existing under the umbrella of NRHM can be
effectively implemented through Medical Colleges.
Important role in pre-service teaching and training of under-graduate and post-graduates
to provide good quality health care services and implementing the programme for the
State’s needs.
Also providing skill upgradation training and enabling the trainees not only to acquire the
skills but also learn to diagnose and treat complications.
Knowledge and skill upgradation during in-service training for various service providers.
Training of district and below district level trainers.
Training of MOs of PHC/CHC (if necessary)
Training of Specialized Skills.
Monitoring & evaluation of NRHM can be done effectively.
Overall involvement of Medical Colleges under NRHM will improve the quality of health
care provider through NRHM.
64
F. Chandigarh
 Name of Participant
Department
1)
2)
3)
4)
Dr. Geetanjali Jindal
Pediatrics, Govt. Medical
Chandigarh-160030
College
&
Hospital,
Sect.32,
Training to district and State level medical and paramedical staffs.
Monitoring activities at district and State level regarding importance of training.
Tele medicine services.
Rural bases research with funds through NRHM.
 Name of Participant
Department
1)
2)
3)
4)
5)
:
:
:
:
Dr. Kana Ram
Asst. Prof. Pediatrics, Govt. Medical College & Hospital, Sect.32,
Chandigarh-160030
Training of peripheral workers through medical colleges
To make protocols to be used at peripheral centre
Funds to medical colleges also
To improve referral system – actually patients really needing tertiary care intervention
Medical colleges should be involved in planning methods of NRHM.
65