Suresh Kishanrao
Nurses have played a pivotal role in Indian health care system. The Bhore committee report in mid-1940’s, envisaged a strong need for providing newer roles for nurses in some far flung rural, tribal, Hilly, and even urban poor populations, where doctors may not be available.
Taking cognisance of non-availability of trained manpower and doctors even in some of the primary health centres, the Government of India (GOI), National Health Mission (NHM) created a new category of community health officer (CHO) with its constructed roles and responsibilities for public health. According to NMC bill 2019, nurses are the first choice for CHO, and this will also pave the way for professional development. Though Community health nursing is integrated in the curriculum of GNM and BSc Nursing courses, their exposure to community health nursing, midwifery and sickness care is limited. To compensate this limitation, GOI initiated a bridge course titled” Bridge Programme of Certificate in Community Health for Nurses (BPCCHN) to update the knowledge and skills of working nurses in public sector in 2017.
National Sampl Surveys Organizations (NSSO) 75th (2017-18) reported proportion of persons that responded as ailing (PPRA) was 7.5% of the (9.1% among urban and 6.8% among rural) population during last 15-day reference period of the survey. Therefore, sickness care is a key intervention under UHC. Currently the private sector provides care to about 70% of outpatient episodes of the population, mainly due to non-availability of sickness care services round the clock and the apathy of public doctors This has led to unregulated private practitioners in health sector, in Rural area. The Primary care places a greater emphasis on the health of the whole person rather than a specific organ or system, contributing to reduction in mortality rates due to comprehensive continuous and accumulated care. Therefore, the need for strengthening sickness care services was emphasized in Universal Health Care (UHC) 2030 goal.
Materials and Methods: This article is an effort to share the experience of first five years (2018-23). Thirty-five (25 R & 10 U) SCHWCs in Karnataka, Maharashtra, Tamil Nadu, Kerala, Andhra Pradesh, Madhya Pradesh, and Utter Pradesh were visited as a consultant for various program reviews and therefore may not be representative but do indicate challenges of CHOs and allow stakeholders to plan appropriate support to them. Observations of CHO’s task performance in general, and some expanded tasks in particular, like diagnosis and treatment of cases beyond minor ailments, common ENT, Oral and Eye conditions, screening for NCDs, mental health disturbances and emergency medical services. Male CHO’s contributions in MCH services (except immunizations) and deliveries both at centre & homes have not added value