greetings !!! - aiims
TRANSCRIPT
Greetings !!! Centre for Community Medicine
The All India Institute of Medical Sciences, New Delhi.
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All India Institute of Medical Sciences
Established in 1956 as an Institution of National Importance by an
Act of Parliament with the objective to:
Develop patterns of teaching in medical education in all its branches so
as the demonstrate a high standard of medical education to all
medical colleges and other allies institutions in India;
To bring together in one place educational facilities of the highest
order for the training of health activity and to attain self-sufficiency in
postgraduate medical education.
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Comprehensive Rural Health Service Project (CRHSP), Ballabgarh
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Centre for Community Medicine
Two Primary
Health Centers
Sub Centers
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Faculties at Centre for Community Medicine
Associate Professor
Associate Professor
Dr. Chandrakant S. Pandav
Professor and Head
Dr. Shashi Kant
Professor
Dr. Puneet Misra
Additional Professor
Dr. Sanjeev K. Gupta
Professor
Dr. Sanjay K. Rai
Additional Professor
Dr. Kiran Goswami
Professor
Dr. Y.S. Kusuma
Associate Professor
Dr. K. Anand
Additional Professor
Dr. Kapil Yadav
Assistant Professor
Dr. Baridalyne N.
Additional Professor
Dr. Anil K. Goswami
Assistant Professor
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CRHSP - Ballabgarh
Ballabgarh,
Haryana
35 Kilometer from AIIMS,
Delhi – Mathura Highway
Founding visionaries
Dr. B. B. Dikshit
Dr. LeRoy R Allen
Ms. Rajkumari Amrit Kaur
Mr. Pratap Singh Kairon
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CRHSP - Ballabgarh
All India Institute of
Medical Sciences
State government of
Haryana
Started in1961 with aid of Rockefeller Foundation
Primarily an academic & health delivery set up
Collaborative project between
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Objectives of CRHSP - Ballabgarh
To evolve through practice and research a
model of comprehensive health services which
is replicable at national level
To orient and train undergraduates and
postgraduates in primary health care especially
rural medicine
To identify and carry out priority operational
research to help and address the needs
of the country
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CRHSP - Ballabgarh at glance
PHC
DAYALPUR
Chandawali
Nawada Junehra
Dayalpur
Shahpur
kalan Garkhera
PHC
CHHAINSA
Atali
Fatehpur
Billoch Naryala
Chhainsa
Jaya Ladholi
Civil Hospital - BALLABHGARH
Intensive Field Practice Area (IFPA)
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Administrative Structure
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Director, AIIMS
Prof. & Head CCM
Professor In-Charge,
CRHSP Ballabgarh
Faculty, CCM Faculty, CCM
Civil Hospital
Ballabgarh
PHC
Dayalpur
PHC
Chhainsa
SMO, Ballabgarh
CMO, Faridabad
Residential postings
Designation Period of posting
Faculty (CCM) Variable time
Senior Resident (CCM) (5) 27 to 30 months
Senior Resident (Other clinical specialties)* 1 to 3 months
Junior Residents (CCM) (6 to 8) 16 months
Interns (18 to 20) 3 months
Under graduate students (7th Semester) (15)# 6 weeks
Nursing students (15) £ 4 weeks
*Medicine, Surgery, Obstetrics and Gynecology, Psychiatry, PMR, Pediatrics, Paediatric Surgery,
Ophthalmology, Radiology
# July to December
£ August to March
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Residential postings
Ballabgarh
Dayalpur Chhainsa
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Academic activities at CRHSP
Under graduates
Post graduates
Interns
Senior Residents
Nursing students
Foreign students
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Academic activities at CRHSP …2
Under graduates
7th Semester students (July to Dec)
Residential
Day start from morning 7 to 7 evening
Epidemiological exercises
IMNCI training
Health system visits
Case and family presentation
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Academic activities at CRHSP …3
Post graduates
Seminars & Case/Family presentations
Monthly report based exercise
MIS based exercises
Disease review
Hospital based Exercise
Survey
Interns
Case study & mortality discussion
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Foreign students
Various universities from United states of America
and United Kingdom
Harvard University
Tulane University
Boston University
University of Pennsylvania
Observership/Internship or carrying short projects
Duration of stay is variable
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Services at CRHSP
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Out Patient Services
Daily Clinics
1. Medicine
2. Surgery
3. Obs & Gynecology.
4. Psychiatry
5. Pediatrics
6. Ophthalmology
7. Immunization Clinic
8. Dental
Specialty clinics
Antenatal clinic
Oto-rhinolaryngology
Physical Medicine &
Rehabilitation (PMR)
Paediatric surgery
Non Communicable Disease
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In patient services
50 bedded ward
Free Delivery
Cases admitted from OPD under
different specialties
Medicine
Surgery
Obstetrics and Gynecology
Ophthalmology
Pediatrics
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Emergency services
24 × 7 service delivery
Medical officers (5 - 6)under Govt. of Haryana
Senior residents of various specialties provide
consultation whenever required
24 × 7 Ambulance service also available
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Investigation done at CRHSP Ballabgarh
Pathology:
Hemoglobin, Blood grouping, TLC, DLC, ESR, peripheral smear, CSF,
Semen analysis
Microbiology
Sputum AFB staining, Peripheral smear for MP, WIDAL, VDRL, stool
microscopy
Bio chemistry
Glucose estimation, RFT, LFT, Lipid profile
Radiology
X ray and Ultrasound
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Out Patient Services Opthalmology
Photo Gallery …1
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Labour Room Nursery
Photo Gallery …2
Operation Theatre at CRHSP
Ballabgarh Emergency services
Photo Gallery …3
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Laboratory services X- Ray
Photo Gallery …4
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Urban tertiary care
Hospital (AIIMS)
Rural Secondary care
Hospital (CRHSP)
Tele - Medicine facility
Tele - Medicine facility
Inaugurated in July - 2005 by the Union Minister of
Health & Family Welfare, Government of India
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Health Management Information System 29
HMIS: DATA COLLECTION METHOD
•Domiciliary visits by male and female Health workers
•Each house in IFPA visited once every 15 days
•Data collected regarding:
•Demographic details
•Morbidity and Mortality
• Health services provided (vaccination, contraception, etc)
•Annual Census
•Supervision/validation by Supervisors and Medical Doctors
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Objectives of HMIS
Research Work
Sampling frame
Demographic data
Maternal and child health data
Monthly work plan
Monitoring and evaluation of health activities
Supervision
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Unique Identification number
Project
area PHC Village House no Family no Individual no
• Each and every individual residing in the IFPA is
provided with unique identification number
• Primary Identification Number: Permanent, 17 Digit
and is alpha numeric
• Secondary Identification number: 12 Digit, changes
according to the house number
State code District code Block code Village
code
DOB code Sex code Random No.
code
First 2 Digit
(11)
Next 2 Digit
(11)
Next 1 Digit
(A,B)
Next 2
Digit
Next 4
Digit
Next 1
Digit
Next 5 Digit
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AIIMS and CRHSP - Ballabgarh (2010-11)
Sno Hospital/
Centre
OPD
Attendance
Casualty
Attendance
Total OPD
Attendance
Admission Surgeries
Performed
Bed
Strength
1 Main
Hospital
13,60,974 1,04,084 14,65,058 72,148 70,894 1045
2 CCM (BLB) 1,36,663 22,391 1,59,054 7,228 1,967 50
We catered to > 10% of total OPD and Casualty
attendance of All India Institute of Medical Sciences
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Civil Hospital, Ballabgarh statistics (2011)
S No. Service Numbers
1 Total number of patients seen on Outpatient Department 160878
2 Total number of patients seen on Outpatient Department (New) 94032 3 Total Antenatal cases registered 5870
4 Total Immunizations administered 7026
5 Total number of admission in inpatient department 8419
6 Bed Occupancy Rate 70.4%
7 Total number of deliveries conducted 2277
8 Total number of Caesarian Section conducted (last 3 months) 64
9 Total number of patients seen in Casualty 27884
10 Total number of laboratory investigations conducted 126461
11 Total number of X rays conducted 12367
12 Total number of USGs conducted (3months) 1513
13 Total number of surgical procedures conducted 2192
14 Total number of Tuberculosis patient treated 552
15 Total number of registration at ICTC 4158
16 Total number of registration at NCD clinic 390
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PHC
DAYALPUR
Chandawali
Nawada Junehra
Dayalpur
Shahpur
kalan Nirhawali
PHC
CHHAINSA
Atali
Fatehpur
Billoch Naryala
Chhainsa
Jaya Ladholi
2 PHCs 12 Sub centers 28 villages
Total population of 90,240
Rural Intensive Field Practice Area
PHC Complex, Dayalpur 36
PHC Complex, Chhainsa 37
PHC Based Services
Daily OPD services
Weekly MCH Clinic
4 Bedded Ward
Delivery Hut (Free Delivery)
Basic investigations (Hb, Urine, P/S Malaria, UPT, etc.), essential drugs
provided free of cost
Monthly sterilization camp at PHC Chhainsa
Designated Microscopy centre at PHC Dayalpur
24 X 7 Service available
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Field Activities
Domiciliary visits by Male and Female Health workers
every fortnight (as per their beat schedule)
Extension Health Clinics once a week in all the villages
Ante natal and immunization clinics at regular intervals
Family welfare services
Supervision of activities by Health Supervisors and
Resident doctors
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Implementation of all National Health Programmes Registration of Births and Deaths
Use of Verbal autopsy for assigning the cause of
deaths
Periodic in service training of ASHAs, Health workers, and health supervisors
Disease control and School Health Services
Field Activities …2
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Achievements 2012
New Cases
Registered
Old Cases
Registered
Total OPD
Registration
PHC Dayalpur 10731 6613 17344
PHC Chhainsa 8588 6371 17344
Total 21462 13226 34688
Total Number of Deliveries Conducted
PHC Dayalpur 247
PHC Chhainsa 405
Total 625
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Indicators monitored at CRHSP
Health indicators
CBR
CDR
IMR
NNMR
U5MR
Service Coverage
CPR
Immunization Coverage
Demographic characteristics of
Ballabgarh IFPA (2011)
Sno. Indicators Result
1 Total Population 90,240
2 Male : female ratio 113
3 Male : female ratio at birth 123
4 Population density 1680 /Km2
5 Population growth/1000 8.5
6 Crude birth rate/1000 23.2
7 Crude death rate/1000 6.7
8 Crude out-migration rate/1000 16.5
10 Crude in-migration rate/1000 7.7
11 Total fertility rate 2.5
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Sno. Indicators Result
14 Under-5 mortality ratio/1000 live births 60.6
15 Life expectancy at birth 67
16 Life expectancy at birth (males) (years) 65
17 Life expectancy at birth (females) (years) 70
18 Immunization coverage 97.4%
19 Institutional Delivery 78.7%
20 Couple protection rate 59%
21 Antenatal care coverage 100%
Demographic characteristics of
Ballabgarh IFPA (2011) 44
Trends in Total Population- IFPA, Ballabgarh
78440
79830
80958 81602
82660 83628
84581 85584
87003
88985
90397
72000
74000
76000
78000
80000
82000
84000
86000
88000
90000
92000
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Trends in Crude Birth Rate- IFPA, Ballabgarh
26.4 26.6
24.9 25
24.4
23.7
22.5
24.1
23.3
24
23.1
20
21
22
23
24
25
26
27
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
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Trends in Crude Death Rate- CRHSP,
Ballabgarh
6.3 6.6
6.9 6.8
6.1
7
6.4
7.4 7.1 7
6.7
0
1
2
3
4
5
6
7
8
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
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Trends in Sex ratio (at birth)- IFPA, Ballabgarh
855 857 858
862
866
869
873 875
878
881
885
840
845
850
855
860
865
870
875
880
885
890
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
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Trend of Child Mortality rates
8.8 12.0
6.7 8.7 7.7 8.0
10.1
15.5 18.2
14.9 17.9 18.3
24.3 24.0
17.4
24.7 23.1 23.3 27.1 28.5 27.2
32.7
37.2
44.9
32.1
37.6
32.8 35.2
54.2
45.9 44.8 44.9
55.9
49.6
53.9
45.7
50.0
44.2 46.1
53.7 56.1
48.2 47.3
59.3
68.4
58.7 60.3
53.0
57.4
92.8
67.9 66.3 67.7
76.6
68.4 68.6
58.1
70.2
58.9 60.2
72.4 68.9
60.6
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
90.0
100.0
per
10
00
liv
e b
irth
s
NNMR IMR U5 MR
49
50
40
50
60
70
80
90
100
110
19
88
19
90
19
92
19
94
19
96
19
98
20
00
20
02
20
04
20
06
20
08
pe
rce
nt
co
ve
rag
e
years
BCG DPT -3 OPV-3 Measles
Trends in Immunization Coverage- IFPA, Ballabgarh
Demographic issues
Realized the need for
Denominators
Birth & Death registration
by MPWs -1975.
Documentation of rates and causes of death at different
ages especially childhood
Focused on Demographic issues till about mid-eighties
when focus shifted to disease specific projects
0
5
10
15
20
25
30
35
40
45
50
1970 1972 1974 1976 1978 1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008
Bir
ths
pe
r th
ou
sa
nd
po
pu
lati
on
Years
Crude Birth Rate
Birth Rate (per thousand …
Contributions of CRHSP to Public Health 51
Operational / Health System
Research
Multipurpose Purpose Health
Worker Scheme -1972.
Addition of Curative services
to MPWs – 1973.
Computerized Health management information system-1988.
Focused on delivery of health services to rural areas
Contributions of CRHSP to Public Health 52
Contributions of CRHSP to Public Health
Pulse Polio strategy (vaccinating
all on a single day) -1985
Diarrhea epidemiology and control
ARI epidemiology and control
Measles Epidemiology and Control
Field trial of High Dose Iron & Folic
Acid for Pregnancy-1987.
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All address national health priorities and
we have led the way
Contribution of CRHSP to National Rural Health Mission
(NRHM)
Technical Support – Member of Task Force(s)
Indian Public Health Standards (IPHS)
Medical Education
Urban health
MOU with National Health Systems Resource Centre
Training - National Level trainers for
Integrated Management of Neonatal and Child Illnesses
Integrated Disease Surveillance Project
District Epidemiologists
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Implementation –
Ballabgarh Block
Providing mentorship
Evaluation
Janani Suraksha Yojana (JSY) evaluation in Jharkhand
Accredited Social health Activist (ASHA) and JSY
evaluation in Faridabad
Contribution of CRHSP to National Rural Health Mission
(NRHM) (cont…)
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CRHSP, Ballabgarh and Research 56
Ballabgarh and Research (cont.)
Sno. Domains of Publications Frequency Percent
1 Non Communicable Diseases 38 24.5
2 Child Health 36 23.2
3 Communicable Disease 17 11.0
4 Women’s Health 16 10.1
5 Health Systems/ Operational Research 16 10.1
6 Demographic Surveillance 8 5.0
7 Medical Education 6 3.5
8 Others 21 12.6
9 Total 158 100.0
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Major Ongoing Research at
CRHSP, Ballabgarh
Direct and Indirect Protection by Influenza Vaccine Given to Children
in India.
Influenza disease burden – Multisite influenza surveillance, Phase II.
Prevention of Type II diabetes in women with pre diabetes used in
vitamin D supplementation and life style intervention in North India
Epidemiological study of Respiratory Pathogens in Acute Respiratory
Tract Infection among Children and elderly in India
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Development of a model for strengthening of existing health
system to address non communicable diseases in India – Phase II
Development of neonatal health care service delivery model for
rural India.
Role of education in Low birth weight
Tobacco consumption in villages under CRHSP
Diabetic and Hypertension treatment adherence
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Major Ongoing Research at
CRHSP, Ballabgarh (2)
National Collaborations
Indian Council of Medical Research
National AIDS Control Organization
Providing technical support to 5 northern states (Bihar,
Delhi, Jharkhand, UP & Uttarakhand) for HIV Sentinel
Surveillance since 2006.
Media Lab Asia
National Health system Resource Centre
Ministry of Health & Family Welfare
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International Collaboration
WHO Collaborating Center for Capacity Building
and Research in Community Based Strategies for
NCDPC.
Member of INDEPTH Network since 2003
Other partners
CDC, UNICEF, INCLEN, WHO, University of Alabama
and Colorado, etc.
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INDEPTH and Ballabgarh
Since 2003, CRHSP Ballabgarh part of INDEPTH Network
One of the 34 Health and Demographic Surveillance System
(HDSS) sites
To help understand health and social issues and apply this
understanding to alleviate the most severe health and social
challenges
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Ballabgarh HDSS
CRHSP - Ballabgarh
All India Institute of Medical Sciences, INDIA
Major Strengths of CRHSP, Ballabgarh
More than 50 years of existence
Self-reliant: being an autonomous body with government funding
Part of All India Institute of Medical Sciences, which is a premier centre of
excellence in the field of medical education and research in India.
Providing curative, preventive and promotive services (Primary and
secondary level)
Health and management Information System: Computerized database since
1991 which is updated every month
Has led to policy changes at National and international level
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Future Plans at CRHSP, Ballabgarh
Increasing the IFPA to more than 120 thousand
population, with the establishment of a new
community health center at Fatehpur Billoch
Formation of a cohort of hypertensive and diabetic
patients
Infrastructure
A new Hospital building
Residential area
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