• Total Services delivery at health center listed: 36
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1
General medicine consultation and treatment
register, ask information, take body temperature, body weight, blood pressure, count pulse and breathing, and inform the section where patients should go next, primary emergency medical service
Outpatient consultation services
2
Patient flow
Patient flow starts from reception, general medicine consultation: child and adult/MCH consultation/delivery, minor surgery and wound dressing/pharmacy, until admitted or referred/go home
Outpatient consultation services
3
Emergency service
First aid and basic life support care (Asphyxia resuscitation, drowning, bleeding of injury, shock, convulsion, unconsciousness, fracture, burnt and inflammation, poisoning, dog bitten, snake and poisonous insect bitten)
Outpatient consultation services
4
Follow up and referral patient
Details about previous sickness and medical treatment history, explanation about time of regular check up, in case of complicated health problems and cannot be treated at health, he/she must be referred to referral hospital for further treatment with referral form.
Outpatient consultation services
5
Ancillary services
Urine test by using dipstick (suspected diabetes), Blood test by using rapid test (detect hemoglobin concentration in order to assess the level of paleness which will require treatment or referring), Malaria test by using rapid test and send blood smear to laboratory department of a referral hospital, Tuberculosis test (sputum test), make sputum smear, and then, send it to laboratory department of a referral hospital, pregnancy test by using dipstick. (Note: some health centers offer HIV test (Volunteer Confidential Counseling Testing)
Outpatient consultation services
6
Antenatal care
Antenatal care should be done periodically at least 4 times (first quarter of pregnancy age, second quarter, early third quarter, at term). Antenatal care should be provided to young pregnant woman without any prejudgment about marital status.
Mother, newborn, child and reproductive health services
7
Normal delivery and delivery with intervention

- Normal delivery using Partograph, record on Mothers Health Record Book and perform management of third stage of labor using Oxytocine
- HIV status should be recorded for every of woman who came for delivery at health center (if there is in the future). Pregnant women with HIV unknown status shall be tested for HIV at labor time. ARV shall be provided to mother with HIV test result positive during labor and delivery, and ARV shall be provided to baby after birth.
- Emergency care (repair vaginal or cervix tear, antibiotics, oxytocic drugs, anticonvulsants, manual removal of placenta, removal of retained products) and they must be referred to referral hospital on time in case of complicated delivery in which the emergency obstetric service (cesarean section) is required.
Mother, newborn, child and reproductive health services
8
Postpartum care
Immediate postpartum care (observe mother every 15 minutes, check body temperature and general condition of the newborn, put baby suck mothers breast within first hour after birth, etc.) and periodical postpartum care or 2 times at least.
Mother, newborn, child and reproductive health services
9
Provision of immunizations to children and mothers/women
Vaccination (tetanus, tuberculosis, diphtheria, poliomyelitis, whooping cough, measles and hepatitis B)
Mother, newborn, child and reproductive health services
10
Nutrition
Infants and Child Feeding Program, Monitoring and Improvement of Child Growth Program, Anemia Control Program (provision of supplementary (daily) iron tablets, prevention against diseases caused by infection and parasite such as: malaria, intestinal worms, diarrhea and HIV/AIDS), Vitamin A Deficiency Elimination Program, Iodine Deficiency Elimination Program
Mother, newborn, child and reproductive health services
11
Prevention of mother to child transmission of HIH/AIDS

- Prevent women, sex partners and their child from getting infected with HIV
- Prevent HIV infected women and family from discrimination and stigmatization
- Provide care and support services to HIV carrier
- improvement of accessibility to and utilization of quality health services, accessibility to information about reproductive health, HIV/AIDS and STD
- Prevention of mother-to-child transmission of HIV/AIDS during pregnancy shall be performed with pre and post test counseling. Confidential counseling and testing as well as other services provided
- Provide support to women comply with the national protocols including counseling, giving ARV, birth spacing, safe sexual intercourse, infant feeding, prevention against other opportunistic infections, especially at postpartum
- Provide mental health support, share their anxiety-fear, and help them contact with community base care network or friend helps friend group.
Mother, newborn, child and reproductive health services
12
Neonatal and young child care
Neonatal care within 24 hours after birth, Care of baby within 3-6 days after birth, Care of baby within 6 week after birth, Referral and Special Care for Baby (convulsion, not sucking, difficult breathing or fast breathing over 60/mn, fever over 38C or body temperature lower 35.5C, umbilical pus)
Mother, newborn, child and reproductive health services
13
Integrated Management of Childhood Illness (IMCI)
Provide integrated management of childhood illness especially to all under-5 years children visiting to health facilities to detect the general danger signs that threat a childs life, and then continue to detect for major signs as follows: respiratory tract infections (cough, difficult breathing), dehydration, dysentery and persistent diarrhea, fever (malaria, dengue and measles), ear infections.
Mother, newborn, child and reproductive health services
14
Birth spacing

- Birth spacing services should be provided to women of reproductive age as needed, voluntarily, optionally and acceptably, and to adult and adolescent men up on need. Birth spacing methods are condom, pill, injection, IUD and Implant as well as permanent contraceptive methods such as tubal sterilization and vasectomy
- If any of contraceptive method is not available at health center, client should be informed a certain facility where the service is available and should be referred for the service
- An appointment for a regular continued contraception as well as the prevention of women of reproductive age from getting infected by HIV, prevention of HIV positive women from having unwanted pregnancy.
Mother, newborn, child and reproductive health services
15
Adolescent reproductive health

- A support by explaining about risks which might happen on too-young mother during pregnancy
- Knowledge about anatomy and reproductive physiology and reason leads to a pregnancy
- Service and counseling on birth spacing, examination and treatment of reproductive tract infections, antenatal care, delivery care, postpartum care, nutrition, substance abuse and gender.
- Encouragement on delay of sexual intercourse contact until they think that they are able to have responsibility for sexual practices
- Advice for making a concrete decision when they feel that they want to have sexual intercourse with someone
Mother, newborn, child and reproductive health services
16
Breast-uterine cancer consultation

- Train women at community on self-examination of breast to prevent breast cancer
- Promotion of awareness of women on importance of cervical examination for detection of cervical cancer and provision of cervical examination service so that women can be treated on time (at present, cervical examination service is available at national hospital and at some NGOs clinics only).
Mother, newborn, child and reproductive health services
17
Safe abortion and post abortion care

- Abortion can be performed at health center in accordance with the Abortion Law and the Implementation Guide of the Abortion Law.
- Service provider should be a trained secondary midwife, a medical assistant or a medical doctor, and is authorized to do abortion
- Preduring and post abortion counseling, procedures of abortion, provision of birth spacing service and post abortion follow up care.
- Post abortion /unclean abortion care includes clinical management of hemorrhage, retained products of conception, birth spacing counseling, maintaining conditions of the women and referring the women on time to a health facility where has ability and capacity to provide treatment.
Mother, newborn, child and reproductive health services
18
Sexually transmitted diseases (STD)
Method of clinical management of the above syndromes is described in details in the National Guideline on Syndromes-Based STD Clinical Management developed by the NCHADS and NMCHC.
Communicable diseases service
19
HIV/AIDS
Roles of home-based care team whose members are staff of health center:
- Provide technical support and share the information about treatment of opportunistic infections and antiretroviral therapy, voluntary confidential counseling and testing, treatment of TB and prevention of mother-to-child transmission of HIV/AIDS.
- Provide counseling and education to AIDS patients and their family
- Manage-prepare home-based care kits
- Manage treatment of minor symptoms
- Visit to patients house
- Facilitates on refer of patient to access to other services at operational district, implement voluntary confidential counseling and testing.
- The roles of health center staff: Voluntary confidential counseling and testing must be arranged in compliance with the guideline of the Ministry of Health, pre and post test counseling Procedures of HIV test must be complied with protocols of the Ministry of Health, In case of test result is positive
a consequent supportive counseling is required
counselor should transfer clients with test result positive to home-based care team or to continuum of care, well collaborate with the National Program for HIV/STD Control of the district and province so that technical capacity can be improved.
Communicable diseases service
20
Tuberculosis

- Implement and disseminate of guideline of the national program to the community
- Explain to TB suspected case, coughing > 15 days, to come for screening at health center
- Identify TB suspected case, collect sputum, transfer sputum cup or sputum slide to a place where laboratory test available
- Explain and refer severe case to referral hospital
- Responsible for provision of TB tablets to patients (mobile DOTS) and collect sputum of 2nd, 5th and 6th month, and then send to laboratory for a control test
- Timely and correctly register all TB patients to be treated
- Search for, explain and invite absent TB patients for treatment again
- Participate in care for and advice to TB-AIDS patients
- Encourage and implement health education on TB
Communicable diseases service
21
Leprosy
- Record every of suspected patient, refer and make writing notice to leprosy responsible person of OD
- Provide information, education and communication (IEC) about leprosy
- Participate in leprosy campaigns and research for new patients
- Provide medicine to patients at health center and every 4 week provides medicine to patients who have no ability to visit to the health center. Encourage patient to come for receiving medicine regularly.
- Explain patients how to take MDT daily and monitor patients take MDT monthly
- Health center staff must contact OD for sufficient MDTs
- Inform and refer patients with a leprosy allergic symptoms, or with side effect or relapsed to the leprosy responsible person at OD
Communicable diseases service
22
Malaria/dengue fever
-Health center should ensure provision of treatment, prevention, and promotion of health services relevant to malaria and dengue fever to community with a high quality and effectiveness in accordance with guidelines and national protocols of the National Malaria Center and acceptable by the community.
-Every malaria diagnosis confirmed by microscope or by dipstick
Communicable diseases service
23
Bird Flu
The patient must be transferred to the hospital where the Ministry of Health authorized for Avian Influenza care so that patient can be rescued on time following standard precautions for infectious diseases control and in compliance with guidelines of the Ministry of Health and WHO.
Communicable diseases service
24
Hypertension
- Screen for high blood pressure patients
- Provide health education-treatment for simple high blood pressure patients (without complications)
- Refer complicated high blood pressure patients to referral hospital
Non-communicable diseases service and other health problems
25
Diabetes
- Screen for people at high risk of diabetes so that they can be provided with health education, advice and referred to diabetes clinic for a confirmed diagnostic.
Non-communicable diseases service and other health problems
26
Breast cancer/uterine cancer
- Know fist sign of common cancer
- Educate women about self breast examination to prevent breast cancer
- Promote womens awareness of risk factors cause of breast cancer
- Promote womens awareness on the importance of cervix screening to detect cervix cancer, and measure for prevention of cervix cancer.
Non-communicable diseases service and other health problems
27
Mental health
Health centers where available with physician or nurse trained on basic mental health are able to provide mental health services in compliance with the guideline of the Mental Health Program. 1. Service delivery:
- Provide basic mental health service
- Accept continuum of care for mental patients transferred from referral hospitals or national hospitals
- Provide tablet or education
- Collaborate with local authority or all authority levels, NGOs, Village Health Support Group to conduct surveillance for severe mental patients who might cause accident to themselves or to others, so that they can be referred to referral hospital or national hospital
- Educate to community, mental patients and patient family about mental health
- Visit to treatment-abandoned patient and advise to return for treatment
2. Mental patients allowed for treatment at health center:
- Common anxiety
- Depression
- Chronic psychiatry
- Non-convulsion alcohol abused
- Epilepsy
- Senile
Non-communicable diseases service and other health problems
28
Oral health
Oral health can be provided by health centers where available with dental nurse only. Basic package of oral care to be provided by those health centers are:
- Oral urgent treatment, traumatic restorative treatment and afford fluoride toothpaste through dental nurses at health centers.
- A dental nurse at health center has two roles: one is a basic package of oral care service provider and another is a usual nurse. A dental nurse can be a care provider and an educator to community people using dental kit, and an oral health educator to schoolchildren of schools located near health center.
Non-communicable diseases service and other health problems
29
Eye care
- Feasible treatment: conjunctivitis and trachoma
- Identify and refer the cases to referral hospital: eye injury, glaucoma, cataract, refractive error
Non-communicable diseases service and other health problems
30
Minor surgery and wound dressing
- A minor peripheral surgery without anesthesia or with local anesthesia, and needs no respirator/ventilator. Examples of minor surgery are: wound surgery, lard-removal surgery, etc.
- Wound dressing is a package activity of wound treatment.
Non-communicable diseases service and other health problems
31
Health education
Dissemination of information relevant to diseases prevention and makes people accept new habit or new performance brought with health. Examples of health education are: education on diarrhea, dengue fever, malaria, tuberculosis, typhoid fever, other communicable diseases, wound care and neonatal cord care, etc.
Health education and health promotion
32
Health promotion
An important role to function the existing National Program for activities of health promotion at their health facility. Those programs include behavioral change in smoking or health, environmental health, food hygiene, primary health care and maternal and child health, etc.
Health education and health promotion
33
Inpatient at Health Center
Health centers where were authorized for admission of patients, for in stance, former district hospitals must use Admission Form, Registration List, etc., provided by the Ministry of Health. Moreover, health centers must comply with clinical guidelines for referral hospital as well as guidelines for national programs concerning inpatient.
Health education and health promotion
34
Guide for outreach services
A method to provide services at community level by health center staff to fulfill the services provided at health center so that all levels of people access to essential health services especially preventive services, and with no affect to the function of health center.
Outreach Services
35
Implementation of outreach services
- It should be at least once a month in a village, it means that at least 12 times per year in a village.
- Essential service package: immunizations service, vitamin A supplementation to children and postpartum women, health promotion service, provision of Oralyte to children of diarrhea, birth spacing service, regular deworming, follow up of TB and leprosy patients, iron tablet complementation to postpartum women, home-based care and follow up of AIDS patient.
Outreach Services
36
Complementary services package at remote villages
Essential services package plus: antenatal care service, follow up of birth spacing activity, neonatal care and counseling on breast feeding and complimentary feeding, health promotion focusing on family key practices including education on protection against communicable and non-communicable diseases and oral health, follow up of some diseases in the community, malaria treatment, and distribution of insecticide treated nets and re-dyeing.
Outreach Services