Medical Service- Measures to improve Health Care Services in Tamil Nadu - Strengthening of Health administration and extension of specialist care at various levels-Orders issued.

HEALTH AND FAMILY WELFARE DEPARTMENT

(Ms) No.736 Dated the 16th May 1991.

ORDER:

With a view to streamlining Health administration, various Directorates in the Department of Health, Indian Medicine and Homoeopathy and Family Welfare Department, have recently been reorganised as per G.O.Ms, No. 25, Health, Indian Medicine & Homoeopathy and Family Welfare Department, dt 7.1.91. Some re-organisation has also been attempted at the District level. This is the first of a series of measures taken to improve delivery of Health Care Services in the State. While expenditure on hospitals and related facilities has progressively increased during the recent years, areas such as improvement of Health administration, extension of specialist care to Rural areas and strengthening of referral system has not received the full attention required to extend quality services to the people. Accordingly, Government have decided to implement a four year plan to strengthen the Health care and administration at various levels, extend specialist care at District level and below and improve the referral system from Community Health Centre, Taluk level, District level to Medical College Hospitals and attached Specialist Institutes.

As part of this plan, during the year 1991-92, the Government sanction the following programme:-

(1) HEALTH ADMINISTRATION:

(i) 55 Taluk and Non -Taluk hospitals with 30 beds or more will be headed by the Civil Surgeons,

(ii) Resident Medical Officers an important functionary in the officers of a hospital. Senior Officers of the Civil Surgeons rank will be posted in the 14 District Head quarters Hospital with 300 beds or more.

ii) 14 District headquarters hospitals with 300 beds or more will be headed by Senior Civil Surgeons in the pay scale of Rs. 3700-5200. Similiarly, the 5 District Headquarters Hospitals with less the 300 beds will be headed by Civil Surgeons

iv) The 3 Superintendents of E.S.I. Hospitals (Ayyanavaram and Coimbatore) and the T.B. Hospital, Nagercoil and 4 Regional Administrative Medical Officers in the E.SI. Scheme will also be Senior Civil Surgeons.

v) Supervision of Medical Institutions in the districts needs to be considerably improved. The officer responsible for this in all 20 Districts will be designated as District Hospitals Services Officer and will be in the Senior Civil Surgeons grade in the merging of Directorate of Family Welfare and Directorate of Primary Health Centres.

vi) Centre with the Directorate of Medical Services, the resultant Directorate of Medical and Rural Health needs to be suitably strengthened and The functions are being looked after by Deputy Directors will be headed by senior administrate officers of the Senior Civil Surgeons rank.

(2) EXTENSION OF SPECIALIST CARE TO RURAL AREAS:

(i) One hundred Community Health Centres will be established during the year by upgrading the existing Primary Health Centres on the Government of India pattern of One upgraded Primary Health Centre for every three Primary Health Centres. As per the Government of India pattern, Community Health Centres will be headed by the Civil Surgeons. Each Community Health Centre will be responsible for total Healthcare Services in its entire jurisdiction of 4 Primary Health Centres (including Community Health Centre) "with proper referral pagesranthe Sub-centre to the Community Health Centres.

ii) Specialist Services at the taluk level will be upgraded in the Speciality of Surgery in 50 taluk and non-taluk hospitals with 48 beds and above the surgery unit being headed by a Civil Surgeon Specialist.

iii) Similarly at the District level, one unit each in Surgery and Medicine will be upgraded and headed by Senior Civil Surgeon Specialists in the 19 District Headquarters Hospitals.

(Iv). Accident and Emergency Services have assumed critical importance with the increase in traffic and industrial accidents. Thirty seven existing units in the State at District / taluk hospitals should each have atleast one Civil Surgeon.

(v) To ensure quality support to Blood Banks and Post Partum Services in the District Headquarters Hospitals, Senior Pathologist or Civil Surgeon should be provided in each District Headquarters Hospital.

(3) Strengthening Referral System From Taluk Level to Medical College Hospital:

(i) Taluk and district level hospitals should function as effective referral centres for serious cases being referred from the Primary Health Centres. To strengthen their capability in this regard, experienced Senior Assistant Surgeons will be posted even in the supporting roles. During 1990-91, five such senior Assistant Surgeons will be provided in the scale of pay of Rs. 2500-4200 to each of the 19 District Headquarters Hospitals, E.S.I, Hospitals at Ayanavaram and Coimbatore and T.B.Hospital, Nagercoil and, one each to the 194Talulk and Non-Taluk Headquarters Hospitals.

(ii) From the Taluk and District levels, a large number of serious cases are referred to the Medical Colleges. There is a need to strengthen both the quality of Medical Education and improve efficiency of provision of Services at the Medical College level as those form the backbone of specialised care Services as also train doctors for Services at the district level below towards this end

(a) All units will be headed by Senior Clinical Professors in the pay scale of RS. 3700-5200, distributed over the 9 Medical Colleges and 16 attached speciality Institutes as per requirement.

(b) Two Readers in each specialities will be provided in the 9 Medical Colleges to strengthen the specialities of Medicine, Surgery, Obstetrics and Gynaecology,Paediatrics, Orthopaedics, Ophthalmology and. E.N.T. Similarly, one Reader each will be provided in the specialities of Radiology, Physciatry, Dermatology, Anatomy, Bio-Chemistry, Venereology, Anaesthesia Physiology, Pharmacology, Pathology, Microbiology and Forensic Medicine in the four out of nine Medical Colleges.

(C) 100 Assistant Professors/Senior Assistant Surgeons will be provided to the 9 Medical Colleges and 16 attached Speciality Institutes as per requirements by converting posts of tutors will be ensured that no tutor, other than those with higher speciality qualifications, who has not gone through Primary Health Centre Services or completed atleast 6 years of service becomes an Assistant Professor.

With such simultaneous-strengthening of specialities/facilities in the Medical Colleges, Speciality Institutes, District and Taluk level hospitals and Community Health Centres, the Referral System is expected to receive the much needed boost to enable it provide quality Services to the needy.

3. The above strengthening/streamlining will be subject to the following:-

(i) No net additional posts will be created, strengthening .will done through adjustment in feeder categories.

(ii) No new units will be created or additional supporting staff provided.

(iii) Wherever upgradations are involved, movement will be in the basis of Civil Medical List for all categories except movement into the category of Readers which will be subject.

3. This order issues with the concurrence of the Finance Department U.O.No.2128A/FS/P/9l dated 22.4.91.

(BY ORDER OF THE GOVERNOR)