HIV/ AIDS prevention and care through community health centres

[Guest guest]

(Moderators note follows the posting)

New standards for community health centres

By Our Staff Correspondent

NEW DELHI, APRIL 12. The Union Health and Family Welfare Ministry

today launched the Indian Public Health Standards (IPHS) for the

community health centres to provide expert care and maintain an

acceptable standard of quality of care. The aim is also to make the

services more responsive and sensitive to the needs of the

community.

Announcing the IPHS at the launch of the National Rural Health

Mission here today, the Union Health and Family Welfare Minister, A.

Ramadoss, said the mission aimed at strengthening referral hospital

care for every one lakh persons as per the new standards. As of now,

the health standards were under the purview of the Bureau of Indian

Standards.

The services assured in community health centres such as routine and

emergency care in surgery, medicine, obstetrics, gynaecology and

paediatrics are to be made available under the IPHS. As regards

manpower, two specialists — anaesthetics and public health programme

manager — would be provided on a contractual basis in addition to

the available specialists. The support manpower will include a

public health nurse and an auxiliary nurse and midwife (ANM) in

addition to the existing staff.

An ophthalmic assistant will be provided at the centres where there

is none at present. The routine and emergency services that the

community health centres must provide include incision and drainage,

hernia, appendicitis, haemorrhoids, and fistula.

They should be able to handle emergencies such as intestinal

obstruction and haemorrhage. Besides, 24-hour delivery services

including normal and assisted deliveries, the centres should have a

full range of family planning services, safe abortion services and

newborn care.

All the National Health Programmes (NHP) will have to be delivered

through the health centres.

The programmes that will be implemented through the community health

centres at the district level include the Revised National TB

Control Programme, HIV/AIDS Control Programme, National Vector-Borne

Disease Control Programme including malaria, filarial, dengue,

encephalitis and Kala-azar, National Leprosy Eradication Programme,

National Programme for Control of Blindness and the Integrated

Disease Surveillance Project.

The centres will also have a blood storage facility, essential

laboratory services and referral (transport) services.

http://www.hindu.com/2005/04/13/stories/2005041302201300.htm

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Note: This is one of the significant policy initiative as it envisages to expand

the essential HIV/AIDS services to the Community Health Centers. In the

hierarchy of rural public health facilities, Community Health Centres come

first, Primary Health Centres next, and finally the subcentres. Each subcentre

is expected to serve a population of around 5000.

The UPA Government’s list of provisions for improving the health of the

population as put forth in its Common Minimum Program (CMP) was short. As a step

towards fulfilling its promises, on January 4, 2005 the UPA cabinet approved the

formation of a National Rural Health Mission (NRHM). The mission will aim at

integrating different vertical programmes, decentralising health care service

delivery at the village, and improving intersectoral action.

'Vertical' implies that machinery responsible for planning, implementing and

monitoring are unique for every centrally funded program and operate without any

coordination with the others. Thus when the pulse polio machinery or the

HIV/AIDS machinery start rolling they do not consider the implications of such a

campaign on the delivery of other health care services say maternal health or

regular immunisation services.

[Guest guest]

Dear All

The IPHS and NRHM are good proposals. Increasing manpower at CHCs

and integration of national programmes at delivery levels are good

pills to poor to show that government is doing something for them.

However many of us know there is nothing new about it. The whole

thing has been presented on fresh paper in fine prints and that's

all about it.

I strongly feel that it will further deteriorate the quality of

whatever health services are available and deliverable in the rural

areas unless the health of health service system is improved.

Auxiliary Nurse and Midwives (ANM) who is the frontliner of the

health service system is supposed to cover a population of 5000 in

normal areas and of 3000 in difficult areas (hilly terrains, forests

etc.) and should be staying at a sub-centre. Each ANM should have a

sub-centre. The sub-centre should have a facility for an ANM to stay

and be available round-the-clock for people besides a clean space

for conducting deliveries. For every 10 sub-centre there should be a

primary health centre which should have proper medical facility

attended by a medical officer round-the-clock.

Aforesaid has been mentioned in the health policies several times

that are IN PRACTICE for a long time. Most of us know the truth

though. Every time new vertical (disease control/prevention)

programmes are designed/implemented the ANM is burdened without

extra assistance or facility to her. Hardly any of the sub-centres

are in shape to allow a female to stay there all by herself without

any basic facility. To top all these, if ANM fails to achieve her

Family Planning targets (which has been abolished on paper) she is

reprimanded and transferred. Achieving the FP targets and lack of

facilities to provide services is frequently quoted by ANMs as a

major reason behind low immunization coverage though they are never

heard.

There is hardly anything left to understand the gap between the

policy and actual implementation that is causing frustration and

apathy among the frontliners who are responsible for service

provision. It is not difficult to comprehend the reason behind poor

quality of health services in rural areas. Should we expect quality

health services (as promised by NRHM and IPHS) when this frustrated

and depressed lot is pushed to the corner with " monitoring and

supervisory committees " and with additional burdens of programmes,

without providing them any support or even talking about it.

Vishwa Deepak

E-mail: <vdeepak@...>