| CARE IN PREGNANCY AND CHILDBIRTH |
| At Community | At AAPLA DAWAKHANA | Referral |
| Early diagnosis of pregnancy Ensuring four antenatal care checks Counselling regarding care during pregnancy including information about nutritional requirements Identifying of high-risk pregnancies and follow up Enabling access to Take home ration from Anganwadi Centre Follow up to ensure compliance to IFA in normal and anemic cases Facilitating institutional delivery and supporting birth planning Post- partum care visits Identifying high risk pregnancies, child births and post-partum cases and facilitating timely referrals | Early registration of pregnancy and issuing ID number and Mother and Child Protection (MCP) card. Antenatal check-up including screening for Hypertension, Diabetes, Anemia. Immunization for pregnant Women-Td, IFA and Calcium supplementation Identifying high risk pregnancies, postpartum cases for regular follow up, timely referral for institutional births and complication mgt. Screening, referral and follow up care in cases of Gestational Diabetes, and Syphilis during pregnancy Provide first aid treatment and referral for obstetric emergencies, e.g., eclampsia, PPH, Sepsis, and prompt referral. | Antenatal and postnatal care of high-risk cases Blood grouping and Rh typing and blood cross matching Linkage with nearest ICTC/PPTCT Centre for voluntary testing for HIV and PPTCT services Normal vaginal delivery and assisted vaginal delivery Surgical interventions like Caesarean section, Management of all complications including ante- partum and postpartum haemorrhage, eclampsia, puerperal sepsis, obstructed labour, retained placenta, shock, severe anaemia, breast abscess. Blood transfusion facilities |
| NEONATAL AND INFANT HEALTH |
| At Community | At AAPLA DAWAKHANA | Referral |
| Home based new-born care through 7 visits in case of home delivery and 6 visits in case of institutional delivery Highrisk new-born – low birth weight/ preterm new- born and sick newborn (with referral as required), Counselling and support for early breast feeding, improved weaning practices. Iron supplementation Adoption of safe and hygiene WASH practices Growth Monitoring Counselling for Early childhood growth and Development. Identification of birth asphyxia, sepsis and referral after initial mgt. Identification of congenital anomalies and appropriate referral Family /community education for ‘prevention of infections and keeping the baby warm Identification of ARI/ Diarrhoea identification, initiation of treatment- ORS and timely referral as required Mobilization and follow up for immunization services | Identification and management of high-risk new-born – low birth weight/preterm/ sick new-born and sepsis (with referral as required), Management of birth asphyxia Identification, appropriate referral and follow up of congenital anomalies Management of ARI/Diarrhoea and other common illness and referral of severe cases. Screening, referral and follow up for disabilities and developmental delays Complete immunization Vitamin A supplementation Identification and follow up, referral and reporting of Adverse Events Following Immunization (AEFI). | Care for low-birth-weight newborns (<2500gms) Treatment of asphyxia and neonatal sepsis, Treatment of severe ARI and Diarrhoea /Dehydration cases Vitamin K for premature babies Management of all emergency and complication cases. |
| CHILDHOOD AND ADOLESCENT HEALTH CARE SERVICES INCLUDING IMMUNIZATION |
| At Community | At AAPLA DAWAKHANA | Referral |
| Growth Monitoring, IYCF continued and enable access to food supplementation- all linked to ICDS Detection of SAM, referral and follow up care for SAM Prevention of Anaemia, iron supplementation and deworming Prevention of diarrhoea/ ARI, prompt and appropriate treatment of diarrhoea/ ARI with referral where needed Pre-school and School Child Health: Biannual Screening, School Health Records, Eye care, De-worming Screening of children under national program to cover 4’D’s Viz. Defect at birth, Deficiencies, Diseases, Development delay including disability Adolescent Health Counselling on- Improving nutrition Sexual and reproductive health Enhancing mental health / Promoting favourable attitudes for preventing injuries and violence Prevent substance misuse Promote healthy lifestyle Personal hygiene- Oral Hygiene and Menstrual hygiene Peer counselling and Life skills education Prevention of anaemia, identification and management, with referral if needed Provision of IFA under National Program for Iron Supplementation | Complete immunization Detection and treatment of Anaemia and other deficiencies in children and adolescents Identification and management of vaccine preventable diseases in children such as Diphtheria, Pertussis and Measles Early detection of growth abnormalities, delays in development and disability and referral Prompt Management of ARI, acute diarrhoea and fever with referral as needed Management (with timely referral as needed) of ear, eye and throat problems, skin infections, worm infestations, febrile seizure, poisoning, injuries/accidents, insect and animal bites Adolescent Health Detection of SAM, referral and follow up care for SAM. Adolescent health- counselling Detection for cases of substance abuse, referral and follow up Detection and Treatment of Anaemia and other deficiencies in adolescents Detection and referral for growth abnormality and disabilities, with referral as required | NRC Services Management of SAM children, severe anaemia or persistent malnutrition Severe Diarrhoea and ARI management Management of all ear, eye and throat problems, skin infections, worm infestations, febrile seizure, poisoning, injuries/accidents, insect and animal bites Diagnosis and treatment for disability, deficiencies and development delays Surgeries for any congenital anomalies like cleft lips and cleft palates, club foot etc. Adolescent Health Screening for hormonal imbalances and treatment with referral if required Management of growth abnormality and disabilities, with referral as required Management including rehabilitation and counselling services in cases of substance abuse Counselling at Adolescent Friendly Health Clinics (AFHC) |
| FAMILY PLANNING, CONTRACEPTIVE SERVICES AND OTHER REPRODUCTIVE CARE SERVICES |
| At Community | At AAPLA DAWAKHANA | Referral |
| Counselling for creating awareness against early marriage and delaying early pregnancy Identification and registration of eligible couples Motivating for family planning (Delaying first child and spacing between 2 children) Provision of condom, oral contraceptive pills and emergency contraceptive pills Follow up with contraceptive users Other reproductive care services Counselling and facilitation of safe abortion services Post abortion contraceptive counselling Follow up for any complication after abortion and appropriate referral if needed Education and mobilizing of community for action on violence against women Counselling on prevention of RTI/ STI Identification and referral of RTI/ STI cases Follow up and support PLHA (People Living with HIV/AIDS) groups Ensure regular treatment and follow of diagnosed cases | Insertion of IUCD Removal of IUCD Provision of condoms, oral contraceptive pills and emergency contraceptive pills Provision of Injectable Contraceptives in MPV districts Counselling and facilitation for safe abortion services Medical methods of abortion (up to 7 weeks of pregnancy) on fix days at the HWC by PHC MO Post abortion contraceptive counselling Follow up for any complication after abortion and appropriate referral if needed First aid for GBV related injuries link to referral centre and legal support centre Identification and management of RTIs/STIs Identification, management (with referral as needed) in cases of dysmenorrhea, vaginal discharge, mastitis, breast lump, pelvic pain, pelvic organ prolapse | Insertion of IUCD and Post-Partum IUCD Removal of IUCD Male sterilization including Nonscalpel Vasectomy Female sterilization (Mini- Lap and Laparoscopic Tubectomy) Management of all complications Provision of Injectable Contraceptives Medical methods of abortion (up to 7 weeks of pregnancy) with referral linkages MVA up to 8 weeks Referral linkages with higher centre for cases beyond 8 weeks of pregnancy up to 20 weeks Treatment of incomplete/Inevitable/ Spontaneous Abortions Second trimester MTP as per MTP Act and Guidelines Management of all post abortion complications Management of survivors of sexual violence as per medico legal protocols. Management of GBV related injuries and facilitating linkage to legal support centre Management of hormonal and menstrual disorders and cases of dysmenorrhea, vaginal discharge, mastitis, breast lump, pelvic pain, pelvic organ prolapse Provision of diagnostic tests services such as (VDRL, HIV) Management of RTIs/STIs PPTCT at district level |
| MANAGEMENT OF COMMUNICABLE DISEASES AND GENERAL OUTPATIENT CARE FOR ACUTE SIMPLE ILLNESS AND MINOR AILMENTS |
| At Community | At AAPLA DAWAKHANA | Referral |
| Symptomatic care for fevers, URIs, LRIs, body aches and headaches, with referral as needed Identify and refer in case of skin infections and abscesses Preventive action and primary care for waterborne disease, like diarrhoea, (cholera, other enteritis) and dysentery, typhoid, hepatitis (A and E) Creating awareness about prevention, early identification and referral in cases of helminthiasis and rabies Preventive and promotive measures to address Musculoskeletal disorders mainly osteoporosis, arthritis and referral or follow up as indicated Providing symptomatic care for aches and pains – joint pain, back pain etc | Identification and management of common fevers, ARIs, diarrhoea, and skin infections. (Scabies and abscess) Identification and management (with referral as needed) in cases of cholera, dysentery, typhoid, hepatitis and helminthiasis Management of common aches, joint pains, and common skin conditions, (rash/urticaria) | Diagnosis and management of all complicated cases (requiring admission) of fevers, gastroenteritis, skin infections, typhoid, rabies, helminthiasis, hepatitis acute Specialist consultation for diagnostics and management of Musculoskeletal disorders, e.g.- arthritis. |
| MANAGEMENT OF COMMUNICABLE DISEASES: NATIONAL HEALTH PROGRAMMES (TUBERCULOSIS, LEPROSY, HEPATITIS, HIV-AIDS, MALARIA, KALAAZAR, FILARIASIS AND OTHER VECTOR BORNE DISEASES) |
| At Community | At AAPLA DAWAKHANA | Referral |
| Screening, Identification, prompt Community awareness for prevention and control measures presumptive treatment initiation and referral as appropriate and specified for that level of care Ensure compliance with follow up medication compliance Mass drug administration in case of filariasis and facilitate immunization for Japanese encephalitis Collection of blood slides in case of fever outbreak in malaria prone areas Provision of DOTS/ensuring treatment adherence as per protocols in cases of TB | Diagnosis, (or sample collection) treatment (as appropriate for that level of care) and follow upcare for vector borne diseases – Malaria, Dengue, Chikungunya, Filaria, Kala Azar, Japanese Encephalitis, TB and Leprosy Provision of DOTS for TB and MDT for leprosy HIV screening, appropriate referral and support for HIV treatment. Referral of complicated cases | Confirmatory diagnosis and initiation of treatment Rehabilitative surgery in case of leprosy |
| PREVENTION, SCREENING AND MANAGEMENT OF NON-COMMUNICABLE DISEASES |
| At Community | At AAPLA DAWAKHANA | Referral |
| Population empanelment, support screening for universal screening for population – age 30 years and above for Hypertension, Diabetes, and three common cancers – Oral, Breast and Cervical Cancer Health promotion activities – to promote healthy lifestyle and address risk factors Early detection and referral for Respiratory disorders – COPD, Epilepsy, Cancer, Diabetes, Hypertension and occupational diseases (Pneumoconiosis, dermatitis, lead poisoning) and Fluorosis Mobilization activities at village level and schools for primary and secondary prevention Treatment compliance and follow up for positive cases | Screening and treatment compliance for Hypertension and Diabetes, with referral if needed Screening and follow up care for occupational diseases (Pneumoconiosis, dermatitis, lead poisoning); fluorosis; respiratory disorders (COPD and asthma) and epilepsy Cancer – screening for oral, breast and cervical cancer and referral for suspected cases of other cancers Confirmation and referral for deaddiction – tobacco/ alcohol/ substance abuse Treatment compliance and follow up for all diagnosed cases Linking with specialists and undertaking two-way referral for complication | Diagnosis, treatment and management of complications of Hypertension and Diabetes Diagnosis, treatment and follow up of cancers (esp. Cervical, Breast, Oral) Diagnosis and management of occupational diseases such as Silicosis, Fluorosis and respiratory disorders (COPD and asthma) and epilepsy |
| SCREENING AND BASIC MANAGEMENT OF MENTAL HEALTH AILMENTS |
| At Community | At AAPLA DAWAKHANA | Referral |
| Healthy life style tips balanced diet, exercise, stress management. Screening using CIDT tool for mental illness Community awareness about mental disorders (Psychosis, Depression, Neurosis, Dementia, Mental Retardation, Autism, Epilepsy and Substance Abuse related disorders) Patient Health Questionnaires 2 to be included in CBAC form. Identification and referral to the AAPLA DAWAKHANA for diagnosis Ensure treatment compliance and follow up of patients with Severe Mental Disorders Support home-based care by regular home visits to patients of Severe Mental Disorders Facilitate access to support groups, day care centres and higher education/ vocational skills | Awareness and stigma reduction activities at individual level & psychoeducation for all groups of MNG conditions Promotion of mental health through family enrichment programme Detection and referral of patients with severe mental disorders Confirmation and referral to deaddiction Centres Dispense follow up medication as prescribed by the Medical Officer at PHC/ CHC or by the Psychiatrist at DH. Counselling and follow up of patients with Severe Mental Disorders Suicide risk assessment, suicide mgt. by gatekeepers, referrals, and follow-up for suicidal ideation and behaviour. Formulation of comprehensive plan for persons with Dementia. Establish linkages with NGOs, Government departments, PRIs, ULBs to facilitate access to entitlements and referral linkages with faith healers and referral and integrated coordination with other programmes. Management of Violence related concerns | Awareness and stigma reduction activities at individual level Diagnosis and Treatment of mental illness Suicide risk assessment, suicide mgt. referral, follow up and emergency management of poisoning Emergency care for seizures Provision of out -patient and inpatient services Counselling services to patients (and family if available) |
| CARE FOR COMMON OPHTHALMIC AND ENT PROBLEMS |
| At Community | At AAPLA DAWAKHANA | Referral |
| Community based services, Counselling and support for care seeking for blindness, other eye and ENT disorders Health Promotion through appropriate IEC with special emphasis on prevention of ophthalmic and ENT problems. Community screening for congenital disorders and referral and early identification of ENT related problems like sign of hearing loss in infants, children and adults. Screening for blindness and refractive errors and ENT problems AWC based screening for children from 6 to 18 year through RBSK. Recognizing and treating acute suppurative otitis media and other common ENT problems | Awareness about common ophthalmic & ENT problems and illness through IEC Screening for visual acuity, blindness, cataract and for refractive errors Identification and treatment of common eye problems – conjunctivitis, acute red eye, trachoma; spring catarrh, xeropthalmia as per the STG Management of common colds, Acute Suppurative Otitis Media, injuries, pharyngitis, laryngitis, rhinitis, URI, sinusitis, epistaxis Early detection of hearing impairment and deafness with referral Diagnosis and treatment services for common diseases like otomycosis, otitis externa, ear discharge etc. First aid for injuries/ stabilization and then referral. Removal of Foreign Body. (Eye, Ear, Nose and throat) Identification and referral of thyroid swelling, discharging ear, blocked nose, hoarseness and dysphagia | Advocacy for ENT services. Management of all Acute and chronic eyes, ear, nose and throat problems Surgical care for ear, nose, throat and eye Management of Cataract, Glaucoma, Diabetic retinopathy and Corneal ulcers and of referral cases. Diagnosis and management of blindness, hearing and speech impairment Management including nasal packing, tracheostomy, foreign body removal etc. Offering support services to hearing aid users e.g., day to day care such as change of batteries, Do’s & Don’ts while handling the aid etc. Counselling and referral of patients with complications and which require surgical treatment. |
| BASIC ORAL HEALTH CARE |
| At Community | At AAPLA DAWAKHANA | Referral |
| Providing awareness about oral health & hygiene, and health care seeking practices through IEC and planned interactive sessions in home visits, community meetings of the VHSNC, MAS and VHNDS/UHNDs and nutritional days in rural and urban area Create awareness, early detection and referral for fluorosis, and other common oral problems like caries, gingivitis and tooth loss etc. Creating awareness about ill effects of Substance Abuse like tobacco, beetle and areca nut, smoking, reverse smoking and alcohol Co-ordinate various Oral Health Care training programs to school teachers, volunteers and other self- Help groups for imparting preventive and promotive oral health education. Participate and coordinate the outreach activities. Symptomatic care for tooth ache and first aid for tooth trauma, with referrals Mobilization for screening of oral cancer on screening day | Providing awareness about oral health & hygiene, and health care seeking practices through IEC and planned interactive sessions. Screening and early identification of common dental problems like gingivitis, periodontitis, malocclusion, dental caries, dental fluorosis and oral cancers, with referral Oral health education about dental caries, periodontal diseases, malocclusion and oral cancers Co-ordinate various Oral Health Care training programs to school teachers, volunteers and other self- Help groups for imparting preventive and promotive oral health education. Management of conditions like apthous ulcers, candidiasis and glossitis, with referral for underlying disease Participate and coordinate the outreach activities of PHC. Symptomatic care for tooth ache and first aid for tooth trauma, with referral Counselling for tobacco cessation and referral to Tobacco Cessation Centres. Maintain records of all the identified oral diseases reporting in the OPD in a standardized recording format. | Providing awareness to OPD patients about oral health & hygiene, and health care seeking practices through IEC and planned interactive sessions Diagnosis and management of oral cancer Monitoring and ensuring quality care and smooth functioning of oral health services Record keeping and maintenance of registries. Conduct various Oral Health Care training programs to schoolteachers, volunteers and other Self- Help Groups. Assured Services: – Management of malocclusion, trauma cases, Tooth abscess, caries Topical application of fluoride for caries prevention. |
| ELDERLY AND PALLIATIVE HEALTH CARE SERVICE |
| At Community | At AAPLA DAWAKHANA | Referral |
Identification of high-risk groups Support to family in palliative care Home visits for care to home bound/ bedridden elderly, disabled elderly persons Support family in identifying behavioral changes in elderly and providing care Linkage with other support groups and day care Centres etc. operational in the area. Community mobilization on promotional, preventive and rehabilitative aspects of elderly. Community awareness on various social security schemes for elderly Identify and report elderly abuse cases, and provide family Counselling
| Home based care must be supported by a home visit by health care professional trained in palliative care and by linkages to day-to-day Centres and hospices to manage situations that are difficult to handle at home. The MPW will be provided with a “Palliative- Care Kit”. Arrange for suitable supportive devices from higher Centres to the elderly /disabled persons to make them ambulatory. Palliative care team should provide out of hours care to those who require end of life care. Referral for diseases needing further investigation and treatment, to PHC/CHC/DH CHOs to undertake Comprehensive Geriatric Assessment twice in a year for cognitive decline, limited mobility, malnutrition, visual impairment, hearing loss, and depressive symptoms. Develop elderly self-help groups named Sanjeevani & ensure involvement of active and mobile elderly in various activities like awareness generation, assessment of fit elders. Undertake monthly visit to bedbound elderly. Ensure mobile elderly & restricted mobile elderly attend yoga/activity sessions at facility Promote healthy behaviors. Promote inter-generational bonding and involvement of elderly, ASHA & MPW to identify volunteers from youth groups. Management of common geriatric ailments; counselling, supportive treatment Pain Management and provision of palliative care with support of ASHA. VHSNCs/JAS/MAS/RWA will ensure availability of benefits from various governments and nongovernmental programs/schemes to the eligible patients/caregivers. | Provide awareness by sensitizing care givers, on prevention of fall, malnutrition and neglect of care, social security schemes, social entitlements etc. referral for complications. Drugs & Consumables: -Essential Drugs including Narcotics should be made available at PHC level. Home care and End or Life Care. Referral for those requiring secondary level of palliative care. Rehabilitation through physiotherapy and counselling Identify care givers and empower them to take care of bed bound elderly. Ensure continuous psychosocial support to family members and other informal care givers of care dependent elderly patients. Impart training to care givers. Provide dietary advice like oral supplemental nutrition etc. for undernourished elderly. Advanced Comprehensive Geriatric Assessment. Provision of diagnostics, equipment, consumables, medicines and services for Elderly leveraging other National Health Programmes. Referral of elderly patients requiring secondary & tertiary care to higher Centre. |
| EMERGENCY MEDICAL SERVICES, INCLUDING FOR TRAUMA AND BURNS |
| At Community | At AAPLA DAWAKHANA | Referral |
| Providing awareness to the community for handling emergencies in health. First aid for trauma including management of minor injuries, fractures, animal bites and poisoning | Providing awareness to the community for handling emergencies in health. Stabilization care with Triaging based on ABCD criteria and first aid before referral in cases of – poisoning, trauma, minor injury, burns, respiratory arrest and cardiac arrest, fractures, shock, chocking, fits, drowning, animal bites and hemorrhage, infections (abscess and cellulitis), acute gastrointestinal conditions and acute Genito urinary condition Identify and refer cases for surgical correction – lumps and bumps (cysts/ lipoma/ hemangioma/ ganglion); anorectal problems, hemorrhoids, rectal prolapse, hernia, hydrocele, varicocele, epidymo-orchitis, lymphedema, varicose veins, genital ulcers, bed ulcers, lower urinary tract symptoms (Phimosis, paraphimosis), and atrophic vaginitis. Facilitate referral and basic management with communication to higher Centre. Administer Td if not immunized. | Triage and management of trauma cases Management of poisoning, Management of simple fractures and poly trauma Basic surgery and surgical emergencies (Hernia, Hydrocele, Appendicitis, Haemorrhoids, Fistula, and stitching of injuries) etc. Handling of all emergencies like animal bite, Congestive Heart Failure, Left Ventricular Failure, acute respiratory conditions, burns, shock, acute dehydration etc. |
| Services to be given by MO at AAPLA DAWAKHANA. | In addition to the above the Medical Officer at AAPLA DAWAKHANA will also manage the clinical cases by proper diagnosis, treatment and follow up of patients. He/she will supervise all the staff members working under UHWC, guide them, monitor their performance to ensure services are available to the community seamlessly. |
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