RAJIV GANDHI UNVERSITY OF HEALTH SCIENCES, KARNATAKA, BANGALORE.
ANNEXURE-II
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
1 / Name of the candidate and address (in block letters) / MR. SANTOSH1 YEAR M. SC. NURSING
FATHER MULLERS COLLEGE OF NURSING
MANGALORE
2 / Name of the Institution / FATHER MULLER COLLEGE OF NURSING
KANKANADY
MANGALORE – 575002.
3 / Course of study and subject / M.Sc. NURSING
COMMUNITY HEALTH NURSING
4 / Date of admission to course / 16-05-2008
5 / Title of the topic
A STUDY TO ASSESS THE TIME UTILIZATION PATTERN OFFEMALE HEALTH WORKERS (ANM’S) AND THE PROBLEMS FACED BY THEM WHILE DELIVERING HEALTH CARE SERVICES IN SELECTED SUB CENTRES OF MANGALORE.
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8 / Brief resume of the intended work
6.1 Need for the Study
A new approach to health care came into existence in 1978, following an international conference at Alma-Ata. This is known as “primary health care”, first proposed by the Bhore committee in 1946 and spread world-wide by international agencies and national government1
In primary health care, village health services are developed into a three tier system according to the size of population2. The sub centre is the most peripheral village based institution in the three tier system of primary health care. It is the first contact point between community and government health set-up. As such it has a pivotal role in providing primary health care to the population. Realizing the importance of sub centre government has given a high priority to them by including the establishment of sub centers under the revised minimum needs programme. Each sub centre covers a population of 3000 in hilly areas and 5000 population in plains. It is manned by 1 multi purpose health worker male and 1 multi purpose worker female /ANM as per national norms3. Sub centre provide services related to maternal and child health, family welfare, nutrition, protection from disease, diarrhoea control, control of communicable disease and others. They also provide health education in concerning areas. Of total 144988 sub centres in India 8143 arein Karnataka. 9822 multi purpose health workers working in these sub centers4.
For a system of health care delivery to be acceptable well it should be responsible to the community it serves. Assessing and identifying the clients need, developing strategies, implementing nursing intervention are the most important aspects of primary health care. Thus the knowledge regarding above is very essential in the primary health care set up in India. Female health workers are the key providers placed at strategic position at the sub centre level. Female health worker or sub centre seldom prepare work plan for the area and continue to work on adhoc basis. Spectrum of services and her availability at sub centre is not known to community.Work schedule of sub centre/ female health worker need to be revised to make it more efficient and relevant to the need of community3.
Human resource development /Human resource management activities to achieve higher levels of output from employees constitute one of the weak areas in South Eastern countries, especially India with its vast pool of employees. There are very few organizations which practice time-tested and proven activities in HRD/ HRM, and as consequence, employee-output are a low 20-30% in Government and other large institutions, especially in health care5.
Studies shows that inadequate supply of drugs, vacant post, heavy work load, maintenance of records and reports are some problems faced by female health workers. Only few studies were conducted in southern part of India on problems faced by female health workers while delivering health care services and their time utilization pattern. The investigator during his field experience has come across many female health workers and found the inadequate supply of drugs, heavy work load, accommodation facilities are few of the problems faced and unable to utilize time correctly. This motivated the investigator to take up the topic.
6.2Review of literature
A research study was conducted on time utilization of staff of two primary health centre’s.Byusing a non-participative observation tool, the data collected twice i.e. November-December and July-August. The finding shows time utilization pattern of multi purpose workers as follows: - time spent in each house 3.3 minute, maternal care (27% & 23%), child care (33% & 29%), Malaria (2% & 11%), tuberculosis (2% & 2%), family welfare (17% & 23%), vital statistics (15% & 10%), others (15% & 10%) 6.
A number of studies have been conducted on health personnel in Myanmar to identify the work pattern of health workers. Studies were conducted in the peripheral health care teams using the technique of activity sampling. Other studies include the time utilization of voluntary health workers in primary health care. Beside work sampling detailed dairies or work log have also been used to document specific worker activity7.
A study of cost accounting of health centre expenditure was carried out in Panjab and Mysore. The information was derived from each health worker function by calculating the money value of all resources including the workers time utilization in performing the various activities within each function as direct service, administration and non productive activities. The findings from Panjab shows in36, 44, 20 percent and in Mysore 40, 43, 17 percent time spent respectively for each of the function. Study recommends that it would cost less to double the number of sub centre in community development block than to add another PHC head quarter to each block8.
Another study assessed the role of multipurpose health workers of a PHC in the delivering of tuberculosis services itanalyzed vis-à-vis the profile of their entire and diverse health activities at the periphery. Six out of 19 PHC were selectedas samples where self administered questionnaire was used to cover the expected activities of a MPW in accordance with the records and reports maintained at the PHC. Work on the basis of a time spent in different activities was observed. The finding shows thetraveling to village and back (1 hour 6 minutes), average time spent in village (3 hours 55 minutes), average time spent in home visit (2 hours 11 minutes) 9.
A study was conducted with the objective to assess the functioning of health worker female and male and list the bottleneck and constraints limiting their performance as well as strength points in their functioning. Data was analyzed regarding the time spent per activity per month in the two sub centre randomly selected PHC. The data was collected using observation checklist, interview and focus group discussion. Findings revealed that health worker female are spending an average 62.43% of time on the field visit and on travel to reach the head quarter from their place of residence, 22.43% of time are being spent on attending meetings, carrying out non-routine work like pulse polio campaign, awareness campaign for HIV etc. Writing work as perceived by workers was the main reason for them to feel over burden. Inadequate supply of drugs, non availability of health workers and less time being spent on curative services, resulted in poor utilization of sub centre10.
6.3 PROBLEM STATEMENT
“A STUDY TO ASSESS THE TIME UTILIZATION PATTERN OF FEMALE HEALTH WORKERS (ANM’S) AND THE PROBLEMS FACED BY THEM WHILE DELIVERING HEALTH CARE SERVICES IN SELECTED SUB CENTRES OF MANGALORE”
6.4. Objectives
- To identify the activities performed by female health workers.
- To analyze the time spent by female health workers on different activities.
- To identify the problem faced by female health workers (ANM’S) while delivering health care services.
6.5. OPERATIONAL DEFINITIONS
Female health worker
In this study female health worker employed by the state government. To work in sub centre consisting of population 3000 in hilly areas and 5000 population in plains. They are trained from recognized training centersfor the periodof one year six months. They are supervised by health assistant and work in areas like,
- Participating in family planning.
-Looking after the work of RCH.
-Preventing communicable disease.
-Participate in dais training.
-Collecting of vital statistics.
-Maintaining record related to sub centre.
-Providing primary health care services.
-Creating awareness among people through IEC programme.
Time Utilization
In this study time utilization refers to the amount of time spent by female health workers on different activities during their duty hours measured by log book.
Problem Faced
In this study problem faced refers to female health worker responses to the difficulties faced while delivering health care services. The data will be obtained by interview and focus group discussion.
Sub centre
In this study it refers to village basedhealth institute in three tier health care system of government covering 5000 population in plains and 3000 in hilly areas. They are manned by one female health worker and one male health worker.Major services at sub centre are maternal and child health, family welfare, nutrition, protection from disease, diarrhoea control, control communicable disease, health education in concerned areas and others.
6.6. Assumptions
- The time spent by female health worker can be measured.
- Female health workers working in sub centre level may be facing some problems while delivering services.
- Time utilization pattern may affect the quality of services.
- Delimitation
Materialand Methods
7.1. Source of data
The female health workers who are posted in selected sub centres of Mangalore taluk with population varying from 3000-5000.
7.1.1 Research design
Explorative survey design
7.1.2 Setting
The study will be conducted in the selected sub centres of Mangalore. In Dakshina Kannada district,there are total 66 PHC’s, 430 Sub centre’s and 444 female health workers are working.
7.1.3 Population
In this study population comprise of female health worker working in the Mangalore taluk. There 136 female health workers are working in 131 sub centersof Mangalore Taluk.
7.2 METHOD OF DATA COLLECTION
7.2.1. Sampling procedure
Purposive sampling
7.2.2. Sample size
30 female health worker working in selected sub centre.
7.2.3. Inclusion criteria for Sampling
- Female health worker who are willing to participate in study.
- Female health worker available at the time of data collection.
- Female health worker who are working specified sub centre.
1. Base line proforma.
2. Log book to assess the female health workers activities in terms of time.
3. Interview and focus group discussion to identify the difficulties faced by female health workers while delivering health care services.
7.2.5. Data collection method
Written permission will be obtained from district health officeand concerned PHC’s. The purpose of the study will be explained to the subjects and informed consent will be taken. Their responses will be assured confidentiality.
Time utilization pattern will be obtained using log book. Interview and focus group discussion will be used to obtain difficulties faced by female health worker while delivering health care services.
7.2.6. Data analysis plan
A master data sheet will be prepared by the investigator to compute the data. The data will be analyzed using both descriptive and inferential statistics (“chi square” test will be used to find association between the difficulties faced and time utilization with selected baseline variables) on the basis of objectives.
7.3.Does the study require any investigation or investigation to be conducted on patients or humane or animals? If so please describe briefly?
No. The study will collect information on time utilizationfrom female health workers using log book. Problem faced by female health workers will be assessed using interview and focus group discussion.
LIST OF REFERENCES
- Park K, Text book of preventive and social medicine, 19th edition, Jabalpur: Bansaridas Publishers, 2007.
- Swarnkar K, community health nursing, 2nd edition,Indore: N R Brothers, 2008. 210-218.
- Functioning of sub centre in the system of primary health care (editorial), Indian Journal of Community Medicine. 2001 April-June 26(2) 59.
- Statistics(online) available from URL:
- Franklin CR. Human resource management in health care. Health action, November 2008 35-37.
- KapoorKS, Anand K, Sharmanna BR, Mullick AK. Time utilization pattern of staff of two primary health centres in Ballargarh Haryana. Indian Journal of Public Health. October-December 1996 40(4) 112-9.
- Than Tun Sein and Win May. A simple methodology to determine provision and utilization of health services.2008 August 20. Available on URL: 1343/section1344/section1350_5243.htm
- Alexander C, Parker LR, SharkaraNarayane BS and Srinivas Murthy AK. Cost accounting of health centre expenditure. Indian Journal of Medical Research. December 1972 60(12) 1849-59.
- RadhaNarayan, Jones A, Prabhakar S and Srikantaramu N. A study of Tuberculosis services as a component of primary health care. Indian Journal of Tuberculosis April 1983 30 (2) 69-3.
- Dr. Datta U. study of functioning of health worker female and male in India. 23 June 2008. available from URL:
9 / Signature of the candidate
10 / Remarks of the guide
11 / Name and Designation of(in block letters)
11.1 Guide / MRS.LEENA.K.C
ASSOCIATE PROFFESOR
FATHER MULLER COLLEGE OF NURSING
MANGALORE
11.2 Signature
11.3 Co- guide (if any)
11.4 Signature
12 / 12.1 Head of the Department / Rev. Sr. JACINTHA D’SOUZA
PRINCIPAL
FATHER MULLER COLLEGE OF NURSING
MANGALORE
12.2 Signature
13 / 13.1 Remarks of the chairman and principal
13.2 Signature