Comparison of curative and preventive health

Programme

Clinical Medicine Community Medicine

1 Objective Cure the patient Improve the health status of
the community.

2 Information Clinical history, Population data, health

required for physical ex. laboratory problems, disease patterns,
initial inv availability of health
assessment services

3 Diagnosis Differential diagnosis Community diagnosis for

and probable action.
diagnosis.

4 Action plan Treatment and Community health

rehabilitation development
 Clinical Medicine Community Medicine
5 Evaluation Follow up and Evaluation of changes in
assessment the health status.
Improvements to address
the needs.

6 Cost Expensive Less expensive. Highly

effectiveness effective.

7 Fundamental Clinician Sees patient Community health worker

Difference after illness has attempts to understand
started and treat the 1.Why the disease exist?
patient to remove the 2.How it can be prevented
underlying problem.
Ie-the epidemiological
approach. Time, Place,
Person
Community
 Community
➢(නව දිවි සුව වැඩසටහන) PRE MARITAL & MARITAL
COUNSELLING
➢ANC
➢CWC
➢FP
➢PPC
➢WWC, REPRODUCTIVE HEALTH
➢ NCD CLINIC
➢SCHOOL HEALTH PRO.
➢ADOLESENTS HEALTH
➢ELDERLY
➢MENTAL HEALTH COUNSELLING PROGRAMME
Environment
 Environment & Epidemic Control
Programme
➢AIR
➢FOOD
➢WATER
➢HOUSING
➢SANITATION
➢WASTE DISPOSAL
➢WORKER’S HEALTH
➢CONTROL OF COMM. DIS.
❑ EPI
❑ FILARIASIS /DENGUE CON.Programme
❑ RABIES CONTROL &
❑ NCD CONTROL
 Roles
➢MANAGER

➢CLINICIAN

➢TEACHER

➢SUPERVISOR

➢COUNSELOR
 DUTIES OF THE MEDICAL OFFICER OF HEALTH
(Manual of the Dept. of Health Part IV)

• Is in-charge of all activities, which he plans and direct.

• Supervises and controls the work of the entire personnel.

• Establishes cordial relations between the people of the area

and the health unit personnel.

• Makes initial health survey and special surveys of the area

and prepares programmes of work based on findings of the
survey.

• On assuming duties of an area that has already been

surveyed reviews work on existing reports and visits area and
prepare programmes based on findings of review.
• Prepares advance programmes.

• Arranges all health educational work.

• Presides at staff conferences.

• Prepares and forwards reports

(weekly/monthly/quarterly and yearly)

• Makes diagnosis of communicable diseases in

consultation with medical officers and private
practitioners.

• Supervises vaccinations.
• Keeps accurate records of morbidity including
communicable diseases and makes and studies.

• Conduct Maternity and Child Welfare and special

Clinics.

• Carries out school medical inspections and arrange

for treatment of defects & Follow up.

• Carries out medical inspection of Estates in his area,

or those assigned to him.

• Supervise the work of

• Maternity home
• Rural hospitals and dispensaries in-charge of
RMP/AMP
• Maintains diaries and score cards (his own, PHI,
PHNS, PHM up to date)

• Acquaints himself with all parts of his health area by

frequent personal visits.

• Is responsible for discipline of his staff.

• Carries out research and scientific investigation.

• Integrates curative and preventive health work.

• Organizes and directs health education work in the

area.
 DISTRICT AND NATIONAL REVIEW
REPORTING FORMATS

Format “A” & “D”

• Formats should be filled completely

• Extracted from H 677a forms
• Analysis factors led to death as
Resources, Policies, Quality of Care, and family and
community factors
• Preventability of death
• Actions taken at institutional, and field level to prevent next
death
• Suggestions for policy makers to prevent next death
 ORGANIZATIONAL STUCTURE OF FHP ct.
MOH/DDHS
Office (pop 60000-100000)
Peripheral
Staff Unit
➢PPA/DO
➢CDS
➢HMA
➢MH
➢Driver
➢Adol.Dental
➢Labourer SPHI FA
PHNS(S) SPHM(S) Clinic
➢Watcher

Dental
Surgeon/
PHI ර ෝග Therapist
මර්දන
(pop 10000-20000) සහ
කා
PHM (pop 3000-5000)
Front Line family Health Worker
For MCH activities
 ORGANIZATIONAL STUCTURE OF FHP
Provincial Level

Provincial Minister Of Health

Provincial Secretary Of Health

Provincial Director Of Health Services

Dep. Provincial Director Of Health Services

MO.MCH
(Curative
Institution) RE
General Hospital
District hospital HEO
MOH/DDHS
Base Hospital RSPHNS
(pop 60000-
100000)
 Records Maintained by PHM

• Registers:-
❖ Eligible Family register H-526
❖ Birth & Immunization R
❖ Pregnant Mothers R H-513
❖ Expected Dates R • Cards :-
❖ Family Planning R ❖ Pregnancy R
❖ Child Health Development R
❖ Family Planning Field R
❖ PHMs Daily statement R

• Returns :-
❖ PHMs Monthly Statement H-524
❖ Family Planning Monthly R
 Sources of Information

➢ Field health staff providing MCH/FP services. PHM,PHI,PHNS

➢ MCH/FP clinic centers
➢ Medical Institutions providing MCH/FP services

Domiciliary Care provided by PHM

Note Book ; H-511

Daily Statement H-523

Monthly Statement H-524

Flow Of MCH/FP Information

PHM Monthly Statement H-524

MOH/DDHS Office

Well woman clinic Information

Estate Health
MCH clinic Return H-527

Quarterly MCH Return H-509

FHB DPDHS
 RETURNS FROM THE MOH OFFICE

• Weekly –

➢Communicable disease Returns

H-399 RDHS

Epid. U

➢Ref. Temp Record

• Monthly –

➢ Monthly stock return of FP equipments H-1158 FHB

RDHS
➢ FP monthly return H-1200 FHB
RDHS
➢ Monthly return of Vaccine RDHS
Drug stores

➢ Monthly return of School health activities

➢ Monthly return of adverse effects following immunization RE
Epid U
➢ Monthly return of Drugs
➢ Monthly Conference return
➢ Monthly Thriposha return
➢ Monthly NCD Return
• Quarterly –

➢ Immunization return Epid. U

RDHS
➢ MCH Return H-509 FHB
RDHS
➢ Quarterly Statement of Supervisory Staff MIS 527 -- MOMCH

➢ Family Planning consolidated return H-1159 --MOMCH

➢ School Health return H-797 DMCH

RDHS
➢ Well women clinic return FHB
RDHS
Risk condition of Pentavalent vaccine

✓ Prematurely less than 36 week of gestation and

required to spend over one week in PBU.
✓ Recent history of significant illness requiring
over one week hospitalization e.g. neonatal
sepsis, pneumonia etc
✓ Severe congenital anomalies which required
prolong hospitalization during neonatal period
✓ History of HHE to previous doses of pentavelant
or any other pertussis containing vaccine
 National Rate (current)-2015
Indicator National Rate Calculated Rate (MOH)
(current)
2019 2020
1 % of Eligible Families 17.3
18.5 17.1
under care of PHM
2 Birth Rate 11.6
14.6 (2019) 12
(per 1000 birth)
3 Perinatal Mortality Rate 13.5
17 (2007) 12.7
(per 1000 births)
4 Still Birth Rate 5.8
7.8 (2009) 5.9
(Hospital)
5 Neonatal Mortality Rate 8.7
7.0(2010) 8.8
(per 1000 LB)
6 Infant Mortality Rate 9.7
9.9 (2010) 11.7
(per 1000 LB)
 Indicator National Calculated Rate (MOH)
Rate 2019
(current)
2020
7 Childhood mortality 1-<5 -
12.2(2010) -
Years (per 1000 1-<5
children)
8 Maternal Mortality Rate 0.5
39.0 (2017) 0.5
(per 100000 LB)
9 Teenage pregnancies(%) 2.6
6.5 (2010) 3.5
10 LSCS Rate (%) 48.6
24.4 (2007) 47.9
11 Low birth weight Rate 13.2
17.5 (2008) 6.2
Index(%)
12 Average Pregnancy 9.6 (2008) 10.3
weight Gain(kg)
 Indicator National Calculated Rate (MOH)
Rate
(current) 2015 2016
Nutritional <2SD <3SD >+2SD <2SD <3SD >+2SD
Status
13 Infant(%) 6.5 2.1 0.6 0.2 3.2 0.4 0.2
(<-2SD)
14 Pre school (%) (2009) 8.4 2.6 0.2 10.3 1.6 0.7
17.2
1 to 2 yrs (<-2SD)
2 to 5 yrs 26 13.6 4.3 0.4 13.6 3 0.4

15 Contraceptive 50.2
Prevalence Rate
50.2
52.4
of Modern (2007)
Methods (%)
16 Prevalence of 10.7
Traditional
11.2
16.0
method(%) (2007)
17 Unmet need(%) 7.3 (2007) 10.0
10.9
 DEFINITION OF MATERNAL DEATH

• ICD 9th classification

A maternal death is defined as the death of a

women while pregnant or within 42 days of
termination of pregnancy, irrespective of the
duration and the site of the pregnancy, from any
cause related to or aggravated by the
pregnancy or its management but not from
accidental or incidental causes.
Maternal deaths should be subdivided into two
groups;(ICD 9th Classification)

1.Direct obstetric deaths

Those resulting from obstetric complications of the pregnant
state (pregnancy, labour and puerperium) from interventions,
omissions, incorrect treatment, or from a chain of events
resulting from any of the above.

2.Indirect obstetric deaths

Those resulting from previous existing disease or disease
that developed during pregnancy and which was not due to
direct obstetric causes, but which was aggravated by
physiologic effects of pregnancy.
 Examples of Direct Maternal Deaths

▪ Death due to PIH/Eclampsia

▪ Death due to Ectopic pregnancy/abortion
▪ Death due to PPH
▪ Death due to septicaemia
▪ Anaesthetic Deaths
▪ Suicide Deaths (Post Partum Psychosis)
▪ Pulmonary Embolism
 Examples of Indirect Maternal Deaths

▪ Disease can get aggravated during pregnancy.

▪ All medical diseases complicating pregnancy.
▪ Death due to Anaemia complicating pregnancy.
▪ Heart diseases – Rheumatic or Congenital.
▪ Hepatic diseases complicating pregnancy.
▪ Malaria
▪ B. Asthma
▪ Pneumonia etc.
ICD 10th classification – added two sub
categories as follows
➢ Late maternal death
A late maternal death is the death of a woman from direct or
indirect obstertric causes more than 42 days but less than one year
after termination of pregnancy.
eg. Death of the mother after eclampsia died due to renal failure on
90th day.

➢ Pregnancy – related death

A pregnancy related death is the death of a woman while
pregnant or within 42 days of termination of pregnancy, irrespective of
the cause of death.
eg. Death due to food poisoning during pregnancy, or murder during
pregnancy.
MATERNAL DEATH INVESTIGATION
OBJECTIVE
Prevent Delay; Prevent Death

❖ All Maternal Deaths could be categorized according to

3-delay model.

1. Delay-in deciding to seek medical care

➢ Low economic status
➢ Low educational status
➢ Low value placed on a Woman’s life
➢ Not recognizing danger signals
2. Delay-in reaching a medical facility with adequate care
➢ Distance
➢ Lack of proper transport
➢ Poor roads
➢ High cost
3. Delay-in receiving Quality care at the facility.
➢ Lack of EOC
 MATERNAL DEATH INVESTIGATION PROCEDURE (FIELD)
NOTIFY
PHM
HOSPITAL DEATH MOH/
HEAD OF THE DDHS
INSTITUTION NOTIFY
NOTIFY BY TEL./FAX/TELEGRAM
(CONFIRMED BY A LETTER)

PDHS/DPDHS/DMCH

FIELD INVESTIGATION
AS A TEAM
MO MCH,MOH/DDHS,PHNS,SPHM,PHM
VISIT THE PHM OFFICE AND MOTHERS RESIDENCE
WITHIN 7 DAYS
H-677a

REPORT H 677a
MCH quarterly return H 509

DPDHS
DMCH
 MATERNAL DEATH INVESTIGATION PROCEDURE (INSTITUTION)

HOSPITAL MATERNAL DEATH

WARD NOTIFY NOTIFY MOH/
HEAD OF THE INSTITUTION
STAFF DDHS
(OBS & GYNE & OTHERS)
NOTIFY BY TEL./FAX/TELEGRAM
(CONFIRMED BY A LETTER)
JMO

PDHS/DPDHS/DMCH(FHB)
SPECIAL UNITS

INSTITUTIONAL INVESTIGATION AS A TEAM

DIRECTOR/MS/VOG/ANESTHETIST/SISTER IC/NO
MO MCH/MOH
WITHIN 7 DAYS
H 677

REPORT

DPDHS
DMCH
 DISTRIC MATERNAL MORTALITY REVIEW (DMMR)

• At district level
Review once in 03 months
This should be organized by MO MCH of the region
❖ To identify factors responsible
❖ To take corrective action

• At Regional level
Regional Review Team
❖ PDHS (Chairman)
❖ DPDHS
❖ Head of Institutions where death occurred
❖ MO MCH
MOH/DDHS of the respective areas of mat. Death
❖ VOG or other relevant consultants may be summoned

Presentation of Maternal Deaths should be done by using format ‘A’ & ‘D’
❖ Identify the corrective actions
❖ Administrative decisions/ follow up should be initiated
 NATIONAL MATERNAL MORTALITY REVIEW (NMMR)

Responsibility – Family Health Bureau, Ministry of Health

● Visit the Province or District on annual basis

collaboration with Sri Lanka College of Obstetrician and Gynecologists
● College of Anesthetists
● Provincial health authority
● Each death will be discussed on three delay model by a panel of
experts
● Use Format ‘A’ & ‘D’
● Deficiencies are identified and categorized as technical and managerial
etc,
● Findings are presented to policy decision will be taken with necessary
circular guidance
● Follow up with series of workshops and seminars.