ANNEXURE 5

Roles & Responsibilities of HWC-SHC Sta

Community Health Ocer (CHO)

The CHO would broadly be expected to carry out public health functions, ambulatory care, management
and provide leadership at the HWC-SHC. They would be responsible for the following:
1. Ensure that all households in the service area are listed, empaneled and a database is maintained- in
digital format/ paper format as required by the state.
2. Provide clinical care as specied in the care pathways and standard treatment guidelines for the range
of services expected of the SHC.
3. Clinical care provision would include coordinating for care/ case management for chronic illnesses
based on the diagnosis and treatment plan made by the Medical Ocer/specialists who will initiate
treatment for chronic diseases, dispense drugs as per standing orders by the medical ocer.
4. Such coordination could be facilitated through processes such as telehealth. However, CHOs can
also provide medicines as per the provisions of Schedule K, Item 23.
5. Focus attention in screening for chronic conditions on screening, enabling suspected cases conrmed
and initiating treatment based on appropriate STGs or on basis of plans made by medical ocer/
specialists. As a team, ensure adherence, along with counselling and support as needed for primary
and secondary prevention eorts. Such chronic conditions would include both non -communicable
diseases and the chronic communicable diseases of tuberculosis, leprosy and HIV.
6. Coordinate and lead local response to diseases outbreaks, emergencies and disaster situations and
support the medical team or joint investigation teams for disease outbreaks.
7. Support the team of MPWs and ASHAs in their tasks, including on the job mentoring, support and
supervision and undertaking the monitoring, management, reporting and administrative functions
of the HWC such as inventory management, upkeep and maintenance, and management of untied
funds.
8. Support and supervise the collection of population-based data by frontline workers, collate and
analyse data for planning and reporting of data to the next level in an accurate and timely fashion.
Use HWC and population data to understand key causes of mortality, morbidity in the community
and work with the team to develop a local action plan with measurable targets, including a particular
focus on vulnerable communities.
9. Coordinate with community platforms such as the VHSNC/MAS/SHGs and work closely with PRI/
ULB, to address social determinants of health and promote behaviour change for improved health
outcomes.
10. Address issues of social and environmental determinants of health with extension workers of other
departments related to gender-based violence, education, safe potable water, sanitation, safe
collection of refuse, proper disposal of wastewater, indoor air pollution, and specic environmental
hazards such as uorosis, silicosis, arsenic contamination, etc.

Medical Ocer (MO) of UHWC

1. Clinical Work
y The Medical Ocer will be organizing and performing duties necessary for the routine Outpatient
services and also ensure emergency cases are attended and taken care of.
y He/she will screen cases needing specialized medical attention, refer them to referral institutions
and will cooperate and coordinate with other institutions providing medical care services in his/
her area.

60 | INDIAN PUBLIC HEALTH STANDARDS | Health and Wellness Centre - Sub Health Centre
 y He/ she will attend all calls from the in-patients, while he/ she is ‘on-call duty’
y As a member of the health care team, he/she will exemplify an example in attitude toward
patients and sta, thereby, performing duties with respect, dignity, privacy, and modesty to the
patients.
y He/ she will be friendly, courteous and sympathetic while working with patients and ensure
privacy and condentiality of the patients.
y He/she will perform any other duties which a Medical Ocer is expected to perform in view of
his position and any other duties which will be assigned as and when required.
2. Public Health Work
y He/she will make arrangements and provide guidance for rendering health care services at the
community level and at the PHC through the Health Assistants, Health Workers and others.
y The Medical Ocer will ensure that all the members of his/her Health Team are fully conversant
with the various National Health & Family Welfare Programs including NHM to be implemented
in the area allotted to each Health functionary.
y He/she will prepare operational plans and ensure eective implementation of the same to
achieve the laid down targets under dierent National Health and Family Welfare Programmes.
y Any services, speciality or otherwise, being rendered in the hospital, its quality delivery and
other necessary coordination will be ensured by the MO
y The MO will ensure the eective implementation of all National Health Programmes –
Reproductive and Child Health Programme, Universal Immunization Programme, National
Vector Borne Disease Control Programme, National Programme for control of Blindness,
Non-Communicable Diseases Programmes, National Mental Health Programme, Control of
Communicable Diseases, Leprosy, Tuberculosis, Sexually Transmitted Diseases and Ayushman
Bharat
y He/she will be responsible for proper and successful implementation of the Programmes in PHC
area, including education, motivation, delivery of services and aftercare.
y He/she will be responsible for all administrative and technical matters regarding the operations
of National Health Programmes in his/her UHWC area.
y He/she will be responsible for all Health Education activities in his/her area.
y He/she will take the necessary steps for institutionalizing public health surveillance and
undertake timely actions in case of any outbreak of epidemic in his/her area.
3. Administrative Work
y He/she will supervise the work, scrutinize the programmes of his/her sta and suggest changes
if necessary to suit the priority of work of sta working under him/her.
y He/she will hold monthly sta meetings to evaluate the progress of work and suggest steps to
be taken for further improvements
y He/she will ensure the maintenance of the prescribed records and registers at UHWC level and
will issue various kinds of certicates in the capacity of a medical ocer.
y He/she will ensure that the problems and grievances of the sta are solved promptly.
y He/she will ensure the condentiality of the patients
y He/she will take actions timely for legal matters, medico-legal cases, RTIs, court cases and
expeditions implementation of orders of the courts.
y He/she will organize training programmes including continuing education for the sta of PHC
and ASHA under the guidance of the district health authorities and Health & Family Welfare

Annexures | 61
 Training Centres and will ensure that the sta working under his oce regularly gets appropriate
training.
y He/she will assess the performance of the sta and arrange for retraining if required.
y He/she will ensure appropriate utilization of funds as per the guidelines and GFR (General
Financial Rules) provisions.
y He/she will ensure auditing procedures are completed well in advance, and audit reports are
furnished to all the concerned authorities.
y He/she will dispose of all of the obsolete / condemned items and vehicles as per the Government
orders in force.
y He/she will monitor and guide the activities of Hospitals/ UHWCs committees, patient welfare
societies of hospitals, village health & sanitation committees.
y He/she will ensure inter-sectoral/ inter- departmental coordination; involvement of community
leaders, various social welfare agencies and people for eective provision of patient centric
healthcare.
y He/ She will be involved in ‘performance audit’ of sta as per the guidelines of ‘Performance
Audit’.
y He/ She will facilitate, coordinate, supervise, monitor and implement the provisions of all the
health sector Acts and the Rules.

Sta Nurses of UHWC

1. Clinical Work
y S/he will assess the needs of the patients in the ward, explain the medicines to be taken, make a
nursing care plan for all patients consulting with ward sister.
y S/he will give direct patient care and allotted responsibility to her/him by the ward sister.
y S/he will provide comfort to the patient and maintain the safety of the patient (universal safety
precaution).
y S/he will be friendly, courteous, and sympathetic while working with patients and ensure privacy
and condentiality of the patients.
y S/he will carry out procedures of admission, discharge and transfer of patient of the ward.
y S/he will take care that discharged patients have a proper understanding of the follow-up
procedures and details of the diet, medication, exercise, etc.
y S/he will be responsible for taking a history of the patient.
y S/he will prepare and assist in the diagnostic procedure in the ward.
y S/he will provide minor dressing in an emergency.
y S/he will administer drugs by injection upon written order of the Doctor.
y S/he will learn the handling of special gadgets & equipment.
y S/he will distribute diet, milk, etc.
y S/he will maintain a duty room in readiness for all time.
y S/he will be responsible for observation of the patient’s condition, take prompt action and report
to the concerned medical ocer.
y S/he will give health education to the patients and their family members under care.
y S/he will make records of all procedures of her/his patients and keep them up to date.

62 | INDIAN PUBLIC HEALTH STANDARDS | Health and Wellness Centre - Sub Health Centre
 y S/he will take care that case papers are not allowed to be handled by anyone except the doctor-
in-charge of the patient. This is specically for medico-legal cases.
y S/he will provide assistance and instructions to the patients and their relatives.
y S/he will be responsible -To provide antenatal, intra-natal, postnatal care as taught in the nursing
curriculum.
y S/he will perform any other duties which a Sta Nurse is expected to perform in view of his
position and any other duties which will be assigned as and when required.
2. Administrative work
y S/he will ensure that all articles are sterilized, all equipment, gadgets, electrical connections,
light, fan etc. are maintained.
y S/he will ensure that the specimens are collected, labelled and dispatched.
y S/he will ensure to escort the patient to and from the department.
y S/he will ensure that the reports are received and given to the patients as well as the doctor is
informed.
y S/he will ensure that the patient’s problems are listened to and help them to solve them through
various means.
y S/he will ensure the condentiality of the patients.
y S/he will ensure that the cultural and religious dierences of the patients are respected.
y S/he will supervise the students and ancillary stas.
y S/he will ensure that all records, outcome indicators as per LaQshya guidelines are maintained.
y S/he will ensure to make the ward clean and tidy, including the bed.
y S/he will keep all articles well-arranged and maintain the inventory.
y S/he will maintain all records and mandates.
y S/he will assist the ward sister in orientation programme of new sta and students and in the
supervision of work of Group D allotted in the ward for maintenance of cleanliness and sanitation.
y S/he will accompany with doctors and senior nursing ocers during ‘ward round’.
y S/he will help ward sister in indenting and checking of drugs, supplies and maintaining
inventories.
y S/he will perform the functions of the ward sister during her/his absence
y S/he will assist in orientation of new sta nurses.
y S/he will support and guide the ASHAs working in the HWC area.
y S/he will participate in sta education and sta meeting.
y S/he will maintain good interpersonal relations with all other sta.
y S/he will give information about MLC cases to Head / Ocer in charge.
y S/he will co-operate in activities related to the National Health Programmes.
y S/he will ensure safe disposal of biomedical waste.
y S/he will keep herself/himself up to date with nursing knowledge by taking part in in-service
education programmes.
y S/he will perform any other duty that may be assigned to her/him from time to time including
eld work.

Annexures | 63
Multi-Purpose Worker-Female (MPW-F) /Auxiliary Nurse Mid Wife (ANM) of HWC-SHC
1. Clinical Work
A. Under the supervision of CHO, the MPW-F/ANM to perform the following functions:
y General OPD services and managing cases at HWC-SHC
y Early registration of pregnancy: issuing of ID number and Mother and Child protection
card
y Antenatal check-up and identifying high risk pregnancies, child births and post-partum
cases.
y Screening, referral of suspected cases and follow up care in case of gestational diabetes
and syphilis during pregnancy, STI/RTI, eye, ENT, TB, leprosy, non-communicable diseases,
vector borne diseases, common mental conditions, substance use and Epilepsy cases,
delays in development and disability and other congenital anomalies.
y Identication and support in management of anaemia, nutritional deciencies, and vaccine
preventable diseases in children and their complete immunization including identication
and follow up, referral and reporting of Adverse Events Following Immunization (AEFI)
y Undertake Diagnostic Services- Pregnancy Test, Haemoglobin, Urine Test, Blood Sugar,
and other point of care diagnostic services specied for dierent service packages.
y Provide rst aid treatment for obstetric emergencies, e.g., eclampsia, PPH, Sepsis and
prompt referral (Type B SHC) and supporting medical team for handling other emergency
situations by coordinating
y Midwifery Services in Sub Centres only where institutional deliveries have been allowed
by the state governments and provide appropriate treatment or refer to higher centres in
cases where ASHA is not able to manage with home-based care.
y Reviewing completed CBAC for cancer symptoms/epilepsy/COPD and refers as appropriate.
y Ensuring patient’s compliance for treatment.
2. Public Health Work
A. Undertake household survey with ASHAs for detailed mapping, enumeration and enrolment of
population being covered in HWC and in urban areas where ASHAs are currently not available,
to identifying population at risk, estimating RCH needs etc.
B. Counselling and Health Education to the community on:
y Danger signs during pregnancy, and teaching them importance of institutional delivery,
early and exclusive breastfeeding, seeking postnatal care, weaning and complementary
feeding, consuming nutritious diet and where to go for delivery.
y Importance of complementary feeding, its components, on consuming supplementary
nutrition at AWCs and consuming iron-rich diet in children to avoid anaemia.
y Childhood and adolescent healthcare services including nutrition, personal hygiene,
sanitation, menstrual hygiene management, healthy living etc. in the community through
home visits and through VHSNDs.
y Family Planning/Education of children/Dangers of sex selection/Age at marriage/
Information on/Disease outbreak/Disaster management/Adolescent Health.
y Care during communicable and vector-borne disease infections.
y Lifestyle modications needed for non-communicable diseases like Hypertension and
Diabetes and importance of regular follow up visits to Health and Wellness Centre or other
facilities for NCDs and ensuring adherence to treatment plans.

64 | INDIAN PUBLIC HEALTH STANDARDS | Health and Wellness Centre - Sub Health Centre
 y Oral Health education especially to antenatal and lactating mothers, school children and
adolescent, rst aid and referral of cases with oral problems.
y Motivation for quitting and referrals to Tobacco Cassation Centre at District Hospital/Medical
College.
y Activities for prevention and early detection of hearing impairment/deafness, visual
impairments at the level of health facility, community and schools.
y Sensitization of community regarding entitlements provided by government under various
national programs
3. Field/Home visits
y Prioritize visit to pregnant women who did not attend their regular ANCs in the monthly ANC
clinics/ VHSND, bring them back to the system -motivate them for institutional deliveries.
y Visits to postpartum mothers for home-based services and providing care - either as indicated by
ASHA after a home visit, or if ASHA is not there, or if they failed to attend VHSND.
y Identify children who missed their immunization sessions and ensure that they get vaccinated
during next immunization session/campaigns.
y Visit sick new-born/low-birth weight babies and children who need referral but are unable to
go, as indicated by ASHA and malnourished children who did not go for the medical reference -
ensure they get care at a higher centre.
y Motivate Families with whom ASHA is having diculty in motivating for changing health-seeking
behavior, adopting family planning methods and who did not come to VHSND.
y Patients having chronic illnesses, who have not reported for follow up at the sub centre or VHSND
and encourage them to attend special-day clinics
y Prioritized visits in areas where Fever Treatment Depots/ASHAs have not been deployed -
Collecting blood smears or performs RDTs from suspected malaria cases during domiciliary visits
and maintains records. Providing treatment to positive cases.
y Distribution and utilization of LLIN Bed Nets; facilitate and ensure quality spray in households
and insecticide treatment of community-owned bed nets.
y Verbal autopsy and/or at least preliminary inquiry into any maternal or child death.
y Surveillance for unusually high incidence of cases of any communicable disease and notify CHO
and PHC-MO.
y Ensuring regular testing of salt at household level for presence of Iodine through Salt Testing Kits
by ASHAs.
4. Administrative Work
A. In ensuring that the untied funds are utilized as per the rules and guidelines.
B. Supportive and Supervisory function to ASHA in:
y Replenishment of drugs in her kit.
y Survey in the community for nutritional deciency among those who had experienced trauma/
disaster/disease outbreak and spreading awareness on nutrition, lifestyle modication diet
post trauma/disaster/disease outbreak.
y In coordinating for building convergence with Women’s Group, Self Help Groups (under
MoRD, GoI) for generating awareness, counselling to promote behaviour change - at
community level and relief camps.

Annexures | 65
 y In coordinating for building convergence with ICDS (AWW) and conduct growth monitoring
at AWC, counselling on nutrition, referral of cases (low weight babies, PW with nutritional
deciency)
y Attending VHSND during disaster - in relief camps for awareness generation on nutrition,
growth monitoring along with other service delivery.
y In community level care for emergency & coordination for rst aid stabilization and follow-
up visit to patient.
y In organizing special “Day Clinics” to enhance attendance for ambulatory outpatient services.
y Support ASHA to ensure home based care for new born and young children.
y Assisting ASHA: Assist the ASHA/similar village health volunteer to motivate the TB patients
in taking regular treatment
5. Functions of Reporting and Record Maintenance:
y Register entries and housekeeping work, data entry; report preparation and review meetings.
y Support CHO in enabling every HWC to have a folder for every family.
y Attending monthly meetings at PHC
y Ensure timely documentation and registration of all births and deaths under the jurisdiction
of Sub Centre.
y Attend VHSNC meetings and ensure that the minutes of the meetings are recorded and
maintained.
y Making and timely submission of reports for various programs i.e. RCH Portal, NCD, HMIS,
IDSP, NIKSHAY etc.

Multi-Purpose Worker-Male (MPW-M) of HWC-SHC

1. Clinical Work

Under the supervision of CHO, the MPW-M performs the following functions:
y General OPD services and managing cases at HWC-SHC that are referred by ASHAs /or visit the
health centre with any illness or problem.
y Identication, referral and follow-up: Mobilize community members including children and
guide them to nearest screening camps, health facilities/Referral centre, for registration, early
identication of gestational diabetes and syphilis during pregnancy, STI/RTI, eye, ENT, TB, leprosy,
non-communicable diseases, vector borne diseases, common mental conditions, substance use
and Epilepsy cases, delays in development and disability and other congenital anomalies.
y Referring of adolescents with anaemia, underweight, issues related to nutrition etc. to AB-HWCs.
Follow-up of sick and malnourished children regarding their nutrition intake, especially those
discharged from NRCs.
2. Public Health Work
y Counselling and Health Education to the community on:
a. Importance of institutional delivery, early and exclusive breastfeeding, seeking postnatal
care, weaning and complementary feeding, consuming nutritious diet and where to go for
delivery.
b. Importance of complementary feeding, its components, on consuming supplementary
nutrition at AWCs and consuming iron-rich diet in children to avoid anaemia.

66 | INDIAN PUBLIC HEALTH STANDARDS | Health and Wellness Centre - Sub Health Centre
 c. Childhood and adolescent healthcare services including nutrition, personal hygiene,
sanitation, vaccination, healthy eating behaviour, in the community through home visits
and through VHSNDs.
d. Activities for prevention and early detection of hearing impairment/deafness, visual
impairments at the level of health facility, community and schools.
y Motivate adolescents to attend VHSND sessions related to adolescent health.
y Sensitization of community regarding entitlements provided by government under various
national programs
y Information and prevention of RTIs, STIs, HIV/AIDS through health education in the community.
y Aware the community and adolescents regarding the various government programmes for
adolescents’ health Nutrition such WIFS, school deworming programme etc.
y Awareness Generation: Utilize meetings of the Village Health Nutrition and Sanitation
Committee/Mahila Arogya Samiti (VHSNC/MAS) to raise awareness about the needs of palliative
care patients, and mobilize individual and community level support, including accessing
assistance available through other Government programmes, assess symptoms
3. Administrative Work
y Facilitate opening of Bank Account, Aadhar card registration of patients and ensure entry in
portals such as Nikshay / TB notication register at health facility for DBT transfer.
y Maintain a record of cases in his area, who are under treatment for tuberculosis and leprosy
y Co-ordinate and participate in the outreach activities of PHC/CHC/ District Mobile dental clinic.
y Attending monthly meetings at PHC
y Supportive and Supervisory function to ASHA.
y Support ASHA in active case detection of cases in the community and referral of suspected cases
with skin patches to MO.
y Assist the ASHA/similar village health volunteer to motivate the TB patients in taking regular
treatment
y In organizing special “Day Clinics” to enhance attendance for ambulatory outpatient services.

Annexures | 67