TADIKELA SUBBAIAH COLLEGE OF

NURSING SHIMOGA, KARNATAKA

SUBJECT: NURSING MANAGEMENT

ASSIGNMENT ON

DEVELOPING
STAFFING
PATTERN
SUBMITTED TO,
Mr. Harish A R
Associate Professor and
HOD of Community Health Nursing
Tadikela Subbaiah College of Nursing
Shivamogga.

SUBMITTED BY,
Mr. Ajay. D
II YEAR M.Sc [N]
Obstetrics and Gynaecological Nursing
Tadikela Subbaiah College of Nursing
Shivamogga.

SUBMITTED ON: 17/09/2024

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 DEVELOPING STAFFING PATTERN IN COMMUNITY
The health care infrastructure in rural areas has been developed as a three sub system and based on the
following population norms:
CENTRE POPULATION NORMS
Plain Area Hilly/Tribal/Difficult Area
Sub-Centre 5000 3000
Primary Health Centre 30,000 20,000
Community Health Centre 1,20.000 80,000

SUB-CENTRES (SCS):
The Sub-Centre is the most peripheral and first contact point between the primary health care system
and the community. Each Sub-Centre is manned by one Auxiliary Nurse Midwife (ANM) and one Male
Health Worker/ MPW (M) (for details of staffing pattern, see Box 1). One Lady Health Worker (LHV) is
entrusted with the task of supervision of six Sub-Centers. Sub- Centers are assigned tasks relating to
interpersonal communication in order to bring about behavioral change and provide services in relation to
maternal and child health, family welfare, nutrition, immunization, diarrhea control and control of
communicable diseases programmes.
The Sub-Centers are provided with basic drugs for minor ailments needed for taking care of essential
health needs of men, women and children. The Ministry of Health & Family Welfare is providing 100%
Central assistance to all the Sub-Centers in the country since April 2002 in the form of salary of ANMs and
LHVs, rent at the rate of Rs. 3000/- per annum and contingency at the rate of Rs. 3200/- per annum, in
addition to drugs and equipment kits. The salary of the Male Worker is borne by the State Governments.
Under the Swap Scheme, the Government of India has taken over an additional 39,554 Sub Centers from
State Governments / Union Territories since April, 2002 in lieu of 5,434 numbers of Rural Family Welfare
Centres transferred to the State Governments / Union Territories. There are 1,45,272 Sub Centers functioning
in the country as on March 2007.

PRIMARY HEALTH CENTRES (PHCS)

PHC is the first contact point between village community and the Medical Officer. The PHCs were
envisaged to provide an integrated curative and preventive health care to the rural population with emphasis
on preventive and promotive aspects of health care. The PHCs are established and maintained by the State
Governments under the Minimum Needs Programme (MNP)/ Basic Minimum Services Programme (BMS).

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At present, a PHC is manned by a Medical Officer supported by 14 paramedical and other staff. It acts as a
referral unit for 6 Sub Centres. It has 4 - 6 beds for patients.

FIG-1. STAFFING PATTERN IN COMMUNITY SECTOR.

STAFFING PATTERN IN COMMUNITY

STAFFING PATTERN
A. STAFF FOR SUB - CENTRE: Number of Posts
SL POSTS NUMBER OF POSTS
No.
1 Health Worker (Female)/ANM 1

2 Health Worker (Male) 1

3 Voluntary Worker (Paid @ Rs.100/- p.m. as 1

honorarium
TOTAL 3

B. STAFF FOR NEW PRIMARY HEALTH CENTRE:

C.

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 SL POSTS NUMBER OF POSTS
No.
1 Medical Officer 1
2 Pharmacist 1

3 Nurse Mid-wife (Staff Nurse) 1

4 Health Worker (Female)/ANM 1

5 Health educator 1

6 Health Assistant (Male) 1

7 Health Assistant (Female)/LHV 1

8 Upper Division Clerk 1

9 Lower Division Clerk 1

10 Laboratory Technician 1

11 Driver (Subject to availability of Vehicle) 1

12 Class IV 4

TOTAL 15

D. STAFF FOR COMMUNITY HEALTH CENTRE:

SL POSTS NUMBER OF POSTS

No.
1 Medical Officer 4

2 Nurse Mid– Wife (Staff Nurse) 7

3 Dresser 1

4 Pharmacist/Compounder 1

5 Laboratory Technician 1

6 Radiographer 1

7 Ward Boys 2

8 Dhobi 1

9 Sweepers 3
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 10 Mali 1

11 Chowkidar 1

12 Aya 1

13 Peon 1

TOTAL 25

Either qualified or specially trained to work as Surgeon, Obstetrician, Physician and Pediatrician. One of
the existing Medical Officers similarly should be either qualified or specially trained in Public Health).

Community Health Centres (CHCs)

CHCs are being established and maintained by the State Government under MNP/BMS programme. It
is manned by four medical specialists i.e. Surgeon, Physician, Gynecologist and Pediatrician supported by 21
paramedical and other staff. It has 30 in-door beds with one OT, Xray, Labour Room and Laboratory
facilities. It serves as a referral centre for 4 PHCs and also provides facilities for obstetric care and specialist
consultations. As on March, 2007, there are 4,045 CHCs functioning in the country. The details of the norms
for each level of rural health infrastructure and current status against these norms.

DEVELOPING STAFFING PATTERN IN COMMUNITY PROJECT

(NRHM- A MODEL CONCEPT ON RURAL HEALTH INFRASTRUCTURE)

Strengthening of Rural Health Infrastructure Under National Rural Health Mission Under the mandate of
National Common Minimum Programme (NCMP) of UPA Government, health care is one of the seven
thrust areas of NCMP, wherein it is proposed to increase the expenditure in health sector from current 0.9 %
of GDP to 2-3% of GDP over the next five years, with main focus on Primary Health Care. The National
Rural Health Mission (NRHM) has been conceptualized and the same is being operationalised from April,
2005 throughout the country, with special focus on 18 states which includes 8 Empowered Action Group
States (Bihar, Jharkhand, Madhya Pradesh, Chhattisgarh, Uttar Pradesh, Uttaranchal, Orissa and Rajasthan),
8 North East States (Assam, Arunachal Pradesh, Manipur, Meghalaya, Mizoram, Nagaland, Sikkim and
Tripura) Himachal Pradesh and Jammu & Kashmir. The main aim of NRHM is to provide accessible,
affordable, accountable, effective and reliable primary health care, especially to poor and vulnerable sections
of the population. It also aims at bridging the gap in Rural Health Care through creation of a cadre of
Accredited Social Health Activists (ASHA) and improves hospital care, decentralization of programme to
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district level to improve intra and inter-sectoral convergence and effective utilization of resources. The
NRHM further aims to provide overarching umbrella to the existing programmes of Health and Family
Welfare including RCH-II, Malaria, Blindness, Iodine Deficiency, Filaria, Kala Azar T.B., Leprosy and
Integrated Disease Surveillance. Further, it addresses the issue of health in the context of sector-wise
approach addressing sanitation and hygiene, nutrition and safe drinking water as basic determinants of good
health in order to have greater convergence among the related social sector Departments i.e. AYUSH,
Women & Child Development, Sanitation, Elementary Education, Panchayati Raj and Rural Development.

The Mission further seeks to build greater ownership of the programme among the community
through involvement of Panchayati Raj Institutions, NGOs and other stakeholders at National, State, District
and Sub District levels to achieve the goals of National Population Policy 2000 and National Health Policy.
Under the strategy of NRHM, in order to fill the gaps in the existing rural health care infrastructure available
in the country, the key components, inter-alia, of the Mission are as given. Below:
 Creation of a cadre of Accredited Social Health Activists (ASHA) in 2.5 lakh villages in four years – 8
EAG States, J&K and Assam.
 Creation of village health scheme and preparation of village health plan – 18+ states.
 Strengthening sub centers with untied funds of Rs. 10,000/- per annum – 10+8+States.
 Raising 2000+CHCs to the level of IPHS.
 Codification of Indian Public health Standards (IPHS) – 18+states.
 Integrating vertical health and family welfare programmes under NRHM at National, State and
District level – all states.
 Strengthening Programme Management Capacities at National State and District level – 10+8+states.
 Institutionalizing district level management of health – all districts.
 Supply of generic drugs (both Allopathic and AYUSH) – 18+States.
 School health check upprogramme – 18+States
 Promotion of multiple health insurance model – all states.
 Supplementing Vitamin ‘A’ and Iron Folic Acid to deficient children at Anganwadi level – 18+states.
 Promotion of private sector for achieving public health goals – all states.
 Setting up of comprehensive Health and Family Welfare clinics – 5 States+select districts.
 Services of ANM and medical officers, PHCs to be ensured at fixed days at Anganwadi levels.
 Mainstreaming ISM. Exploring new Health Financing Mechanism, Policy reforms in Medical
Education and Public Health Management.

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  The mission shall focus on rural areas since bulk of the strategic interventions are aimed at
improvement of primary health care in rural areas.

OVERVIEW OF NRHM:
 The National Rural Health Mission is being launched for a period of seven years (2005-2012) i.e. 2
years of Tenth Plan and full Eleventh Plan.
 The Mission shall cover entire country, with focus attention on 18 states having weak demographic
indicators/ infrastructure.
 NRHM is an omni-bus broad band programme, and all other programmes would be sub-components,
retaining the sub-budget heads wherever required for vertical programmes.
 The emphasis under NRHM is to improve primary health care, decentralization, intra and inter-
sectoral convergence and community ownership.
 NRHM provides broad policy guidelines – states have flexibility to draw their action plans to attain
the goals of NRHM
 RCH-II, including National Family Welfare Programme (NFWP) and Empowered Action Group
(EAG) are subsumed into NRHM.
 Operational phase of the Mission is from April, 2005.
 MOUs being entered into, with the State Governments for RCH-II, will be broad based for NRHM, to
ensure their commitments to the systemic reform and new financial pattern of performancebased
funding under NRHM.

FUNDING:
The budget outlay for National Rural Health Mission for 2005-06 is Rs. 6731.16 Crores.

MISSION OUTCOME:
The following are anticipated Mission outcomes likely to be achieved after its implementation:
 Provision of village level health provider (ASHA) in underserved villages
 Strengthening Sub- centers /PHCs
 Raising CHCs to the level of IPHS
 Institutionalizing District level Management of Health (all districts)
 Prevention and control of communicable and non communicable diseases including locally endemic
diseases.
 Increase utilization of First Referral Units from less than 20% (2002) to more than 75 %2010

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  Reduction in communicable diseases, MMR, IMR and would help in attaining population stabilization.

NRHM PLAN OF ACTION FOR INFRASTRUCTURE STRENGTHENING:

Component (A): Accredited Social Health Activists:
 Every village/large habitat will have a female Accredited Social Health Activist (ASHA)
 Chosen by and accountable to the panchayat- to act as the interface between the community and the public
health system. States to choose State specific models.
 ASHA would act as a bridge between the ANM and the village and be accountable to the Panchayat. She
will be an honorary volunteer, receiving performance-based compensation for promoting universal
immunisation, referral and escort services for RCH, construction of household toilets, and other healthcare
delivery programmes.
 She will be trained on a pedagogy of public health developed and mentored through a standing mentoring
Group at National level incorporating best practices and implemented through active involvement of
community health resource organisations.
 She will facilitate preparation and implementation of the Village Health Plan along with Anganwadi
worker, ANM, functionaries of other Departments, and Self-Help Group members, under the leadership of
the Village Health Committee of the Panchayat.
 She will be promoted all over the country, with special emphasis on the 18 high focus states the
Government of India will bear the cost of training, incentives and medical kits. The remaining components
will be funded under Financial Envelope given to the states under the programme.
 She will be given a Drug Kit containing generic AYUSH and allopathic formulations for common
ailments. The drug kit would be replenished from time to time.
 Induction training of ASHA to be of 23 days in all, spread over 12 months. On the job training would
continue throughout the year.
 Prototype training material to be developed at National level subject to State level modifications.
 Cascade model of training proposed through Training of Trainers including contract plus distance learning
model.
 Training would require partnership with NGOs/ICDS Training Centres and State Health Institutes.

Component (B): Strengthening Sub-Centers (SC)

 Each sub-centre will have an Untied Fund for local action @ Rs. 10,000 per annum. This fund will be
deposited in a joint Bank Account of the ANM & Sarpanch and operated by the ANM, in consultation
with the Village Health Committee.

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 Supply of essential drugs, both allopathic and AYUSH, to the Sub-centres.
 In case of additional Outlays, Multipurpose Workers (Male)/ Additional ANMs wherever needed, sanction
of new Sub-centres as per 2001 population norm, and upgrading existing Sub-centres, including buildings
for Sub-centres functioning in rented premises will be considered. 2.8.3 Component (C): Strengthening
Primary Health Centres (PHCs).
 Mission aims at strengthening PHCs for quality preventive, promotive, curative, supervisory and outreach
services.
 Adequate and regular supply of essential quality drugs and equipment (including Supply of Auto Disabled
Syringes for immunisation) to PHCs.
 Provision of 24hour service in at least 50% PHCs by addressing shortage of doctors, especially in high
focus States, through mainstreaming AYUSH manpower.
 Observance of Standard treatment guidelines & protocols.
 In case of additional Outlays, intensification of ongoing communicable disease control programmes, new
programmes for control of non-communicable diseases, upgradation of 100% PHCs for 24 hours referral
service, and provision of 2nd doctor at PHC level (1 male, 1 female would be undertaken on the basis of
felt need. Component (D): Strengthening Community Health Centres (CHCs) for First Referral Care.

A key strategy of the Mission is:

 Operationalising 3,222 existing Community Health Centres (30-50 beds) as 24 hour First Referral Units,
including posting of anaesthetists.
 Codification of new Indian Public Health Standards" setting norms for infrastructure, staff, equipment,
management etc. for CHCs.
 Promotion of Stakeholder Committees (Rogi Kalyan Samitis) for hospital management.
 Developing standards of services and costs in hospital care.
 Develop, display and ensure compliance to Citizen's Charter at CHC/PHC level.
 In case of additional Outlays, creation of new Community Health Centres (30-50 beds) to meet the
population norm as per Census 2001, and bearing their recurring costs for the Mission period could be
considered.
 Another important intervention under NRHM is the provision of a Mobile Medical Unit at District level for
improved outreach services.

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 STAFFING PATTERN OF NURSING INSTITUTION ACCORDING TO INDIAN
NURSING COUNCIL

TEACHING FACULTY
BASIC B.SC. NURSING
Admission Capacity
Annual Intake 25-50 51-100
Professor-cum-Principal 1 1
Professor-cum-Vice Principal 1 1
Reader/Associate Professor 1 2
Lecturer 5 10
Tutor/Clinical Instructor 14 28
Total 22 42
Teacher Student Ratio= 1:10
B.Sc.: NURSING (POST BASIC) Minimum-30
Annual Intake Minimum-30 Maximum-50
Professor-cum-Principal 1 1
Professor-cum-Vice Principal 1 1
Reader/Associate Professor 1 3
Lecturer 5 7
Total 8 12
Teacher Student Ratio= 1:10

BASIC: B.Sc. NURSING & B.Sc. NUSING (POST BASIC)

Annual Intake
B.Sc. Nursing (Basic) 50 or less
B.Sc. Nursing (Post Basic) 30 or less
Professor-cum-Principal 1
Professor-cum-Vice-Principal 1
Reader/Associate Professor 2
Lecturer 6
Tutor/Clinical Instructor 18
Total 28
Teacher Student Ratio= 1:10
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BASIC: B.Sc. NURSING, B.Sc. NURSING (POST BASIC) & M.Sc. NURSING
Annual Intake PION
B.Sc. Nursing (Basic) 50 or less 60
B.Sc. Nursing (Post Basic) 30 or less 75
M.Sc. Nursing 10 or less 25
Professor-cum-Principal 1 1
Professor-cum-Vice- 1 1
Principal
Reader/Associate Professor 5 3
Lecturer 7 3
Tutor/Clinical Instructor 18 10
Total 32
Teacher Student Ratio: Basic & Post Basic B.Sc. Nursing 1: 10 18
M.Sc. Nursing 1: 5
BASIC: B.Sc. NURSING & M.Sc. NURSING
Annual Intake
B.Sc. (N)Basic 50 or less
M.Sc. Nursing 10 or less 10 or less
Professor-cum-Principal 1
Professor-cum-Vice-Principal 1
Reader/Associate Professor 5
Lecturer 5
Tutor/Clinical Instructor 14
Total 26
Teacher Student Ratio: M.Sc. Nursing 1: 5
Basic B.Sc. Nursing 1: 10

Part time Teachers/External Teachers

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 1. Microbiology
2. Bio-Chemistry
3. Bio-Physics
4. Psychology
5. Nutrition
6. English
7. Computer
8. Hindi/Any other language
9. Any other- clinical disciplines

NOTE:

 Minimum one M.Sc. faculty for each specialty i.e. Medical Surgical Nursing, Pediatrics, Obstetrics,
Community Health Nursing, Psychiatry is required for basic programme.
 No part time nursing faculty will be counted for calculating total no. of faculty required for a college.
 Irrespective of number of admissions, all faculty positions (Professor to Lecturer) must be filled.
 Irrespective of number of admissions all faculty positions (Professor to Lecturer) must be filled.
 Proportional ratio of tutor/clinical instructor as per student intake.
 For M.Sc. (N) programme appropriate number of M.Sc. faculty in each specialty be appointed subject to
the condition that total number of teaching faculty ceiling is maintained.
 All nursing teachers must possess a basic university or equivalent qualification as laid down in the
schedules of the Indian Nursing Council Act, 1947. They shall be registered under the State Nursing
Registration Act.
 Nursing faculty in nursing college except tutor/clinical instructors must possess the requisite recognized
postgraduate qualification in nursing subjects.
 Holders of equivalent postgraduate qualifications, which may be approved by the Indian Nursing Council
from time to time, may be considered to have the requisite recognized postgraduate qualification in the
subject concerned.
 All teachers of nursing other than Principal and Vice-Principal should spend at least 4 hours in the clinical
area for clinical teaching and/or supervision of care every day.

(Number of staff to be increased as per the number of programs and students)

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S.N. Post Qualification & Experience
1. Professor-cum- − Masters Degree in Nursing
Principal − 14 yearsexperience after M.Sc. (N) in college of Nursing.
− 3 years experience in administration (Years of experience is
relaxable if suitable candidate is not available) (If a candidate is not
available, minimum 5 years of experience in college of nursing with
an aggregate of 14 years teaching experience)
Desirable: Independent published work of high standard/doctorate degree /M.Phil.
2. Professor- − Masters Degree in Nursing
cumVice − 14 years experience after M.Sc. (N) in college of Nursing
Principal
− 3 years experience in administration (years of experience is relax
able if suitable candidate is not available) (If a candidate is not
available, minimum 5 years of experience in college of nursing, with
an aggregate of 14 years teaching experience)
Desirable: Independent published work of high standard/doctorate degree/M.Phil.
3. Reader/Associate − Master Degree in nursing
Professor − 10 years experience after M.Sc. (N) in a college of Nursing. (If a
candidate is not available, 5 years of experience in College of Nursing
with an aggregate of 10 years teaching experience.
Desirable: Independent published work of high standard/doctorate degree/M.Phil.
4. Lecturer − Master Degree in Nursing.
− 3 years teaching experience after M.Sc. (N)
5. Tutor/Clinical − Master Degree in Nursing OR B.Sc. (N) Degree (5) years
Instructor experience after B.Sc. (N)

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